Righting a Wrong: Psychiatrists Honored for Vietnam Service

Alicia Ault

November 09, 2018

On a bright, blustery fall day in early November, 17 former US Army psychiatrists gathered on a grassy expanse on the National Mall in Washington, DC, near the Vietnam Veterans Memorial, awaiting recognition that had been a long time coming.

On that day, the American Psychiatric Association (APA) held a ceremony to honor them, and almost 200 of their peers, all of whom had served in the Vietnam War.

One officer, US Army Captain Peter B. Livingston, never made it back. His name — one of 58,000 recorded on the Vietnam Memorial's 400 feet of black granite slabs — is etched into Panel 38 West, Line 12.

It was at this spot that the APA leadership, along with Livingston's widow Cynthia, and retired US Army Colonel and psychiatrist Norman "Mike" Camp, MD, 77, placed a wreath as a tribute to the only known psychiatrist to have been killed in the Vietnam War.

On his way to meet his wife and son in Hawaii for a break, Livingston's helicopter went down — likely because of mechanical failure — on November 19, 1968.

The APA ceremony was not just an acknowledgment of the 50th year since the height of the war, but an explicit apology to those mental health professionals who had given their all, but had been ignored, forgotten, and during and soon after the war, even pilloried for their participation in the military effort.

Left to right: James R. Batterson, MD, Speaker of the Assembly of the APA; Altha Stewart, MD, president of the APA; Cynthia Livingston, widow of US Army Capt Peter B. Livingston, MD; Saul Levin, MD, MPA, CEO and medical director of the APA.

Righting a Wrong

APA President Altha Stewart, MD, said that after taking an honest look at the organization's history it was time to right a wrong.

"There are times in our past when we may not have done as good a job as we might have wanted in addressing some of the realities that occur in the lives of many of the people, including minorities, under-represented groups, and also our veterans," said Stewart at the ceremony.

"It is an honor to stand before you today to say thank you for your service then, and to say to active service members, thank you for your service today," she said.

Cynthia Livingston, who had actively campaigned against the war, was happy with the APA's recognition, especially as her late husband's service had never been acknowledged anywhere, aside from a recent small ceremony at Yale University, where he attended medical school.

"To me, that was extremely moving to have that, because there's been just this hole for a very long time," she told Medscape Medical News.

"It's taken 50 years for the professional community, which is a reflection also of American society, to come to terms and at least acknowledge the soldiers that fought and people like myself who were part of the war effort," said New York psychiatrist Lawrence Bryskin, MD, who served from August 1967 to August 1968 as chief psychiatrist for the US Army's 25th Infantry Division. Based in Cu Chi, a village between Saigon and the Cambodian border, Bryskin was responsible for psychiatric services for 10,000 to 15,000 soldiers.

Being at the ceremony was "almost like a form of grief over the loss of people and disappointment that we've gone through," said Bryskin.

From Animus to Respect

In 1971, after an APA poll determined that a majority of its membership was against the war, the organization officially called for the United States to immediately withdraw.

The APA also eliminated the military psychiatry section from its annual convention, Camp told Medscape Medical News. That created a rift that isolated those in the military at the time of their greatest need, he said.

"It really forced the psychiatrists in the field to operate alone in dealing with these horrific ethical conflicts, such as sending people back to duty after they developed psychiatric symptoms," Camp said.

Many of those at the ceremony said the recognition of the veterans would not have happened without Camp's hard work. Camp served in Vietnam from 1970-1971 as commanding officer of the 98th Neuropsychiatric Medical Specialty Detachment ("KO"), one of two Army treatment units. Troops could receive up to 30 days of treatment before being sent back to combat or evacuated.

It was a difficult year — heroin use was epidemic and troops were actively challenging military leadership, in some cases threatening or attempting assassinations of leaders, said Camp. By 1972, one in eight soldiers was medically evacuated for psychiatric reasons, usually because of drug dependency.

That figure was one of many cited in A Call to Recognize and Honor the Psychiatrists Who Served in Vietnam, the proclamation developed by Camp and Richmond, Virginia-area psychiatrist Adam Kaul, MD, which was eventually approved by the APA Assembly in May 2018.

For Camp, it was almost the apotheosis of decades' worth of personal reckoning, and the icing on the cake of a multiyear, epic investigation into the individual and collective cost of Vietnam on soldiers, psychiatrists, and psychiatry.

That investigation culminated in a 596-page book, US Army Psychiatry in the Vietnam War: New Challenges in Extended Counterinsurgency Warfare, published by the Army's Borden Institute in 2014.

While working on the book, Camp found the Army's official psychiatric records had either been lost or destroyed. He tracked down psychiatrists who had served in the Army on his own.

He found 135 names; eight had died and he estimated that probably another 70 psychiatrists had served with other military branches. While those he corresponded with were enthusiastic about talking, most were bitter — about the war, and how they and those who had served were treated in the aftermath, said Camp.

Tet Offensive

After the book's publication, he contemplated the upcoming 50th anniversary of the Tet Offensive and how it might be time for a reckoning on a professional level.

In 1968, the North Vietnamese began an attack on the south that in many ways was considered to be a turning point in the war. As US casualties hit 500 a week, Americans at home began doubting the veracity of their leaders' claims that their nation was winning the war.

Now the US government has taken steps to commemorate those who served and gave their lives. Starting in 2012, the Defense Department‒backed United States Vietnam War Commemoration effort has been supporting ceremonies across the country. This year is considered pivotal.

Camp put together his proclamation believing that it would be fitting in this year of commemoration. "And it seemed to me that it would be a kind of 'welcome home' thing — after our colleagues and our organization repudiated this service," he said.

When it came to approving Camp and Kaul's call for recognition, the APA assembly was "very united, because we were in the belief that not only was the action it requested a good idea, but it was the right thing to do," said Bob Batterson, MD, a former captain in the US Navy Reserve Medical Corps and speaker of the APA Assembly at the November ceremony.

Psychiatrists who served faced many challenges, including working with medications that had not previously been used on the battlefield, such as neuroleptics, anxiolytics, and tricyclic antidepressants.

Improvisation was a given. As the war worsened, "and despair and its behavioral expressions skyrocketed, the deployed psychiatrists only had a limited capacity for making this bearable," according to Camp and Kaul's resolution. Meanwhile, the "soldiers believed that it was the duty of the mental health contingent to relieve them of their unbearable situation."

Psychiatrists "performed their duty in the face of enormous personal risk and professional challenges," said Batterson. "Today, we recognize their selfless service both to their country and to the soldiers, sailors, airmen, and Marines that they treated during the conflict," he said.

Healing Old Wounds

Some of those psychiatrists also helped their colleagues — even if it wasn't formal care. Former US Army Nurse Jane McCarthy, CRNA, PhD, FAAN, who attended the APA ceremony, said she will never forget Camp's kindness in regularly inviting her and another nurse friend "up to his hooch" for gin and tonics at the end of their 12-hour shifts at the 95th Evacuation Hospital in Da Nang, where Camp's psychiatric unit was based at that time.

McCarthy also served from 1970-1971. Towards the end, "I became numb," she said. She recalls that "at noontime, I'd walk outside — it was hot — and I'd just cry and go back in and go back to work. And I remember thinking, 'That's odd. That's odd.'"

Even during the war, she says she was in conflict with the mission, but she patched up the wounded, as her profession demanded. Psychiatrists faced an equally tough challenge, said McCarthy.

"We had soldiers who came in who shot themselves in the foot to get the hell out of war," she said, adding that she saw at least one who had shot himself in the abdomen in an effort to be shipped out.  

Within 6 months of her return, she was having classic symptoms of post-traumatic stress disorder but did not know it at first. With treatment, time, and talking with colleagues who had been in Vietnam, the symptoms receded — until 1991, and the Persian Gulf War. McCarthy reached out to Camp, with whom she kept in contact and helped guide her to a new round of treatment.

It took another 4 years of intensive therapy to emerge, she said — 25 years after spending a single year in Vietnam.

The APA ceremony is well-deserved, though a little late, said McCarthy, expressing dismay that "it's taken all these years to acknowledge the work that Mike and others did in Vietnam."   

Camp said the APA commemoration served as a means to honor, approve, and celebrate psychiatrists who did what the government asked of them. And, perhaps, it would have "a ripple effect for people of Vietnam age that helps bring some closure, peace, to troubled feelings," especially for veterans, he said.

"Beyond that, I’m hoping it helps to boost the morale and status and self-esteem of those who are serving now in the military in mental health fields about their work and its value," said Camp.

Although he was recognized for his service with a Bronze Star, the acknowledgment from his profession was equally important. It's maybe not so bad that it's taken this long, said Camp. "But, on the other hand, I do feel that way, to some measure."

Cynthia Livingston, too, harbors some bitterness that her husband was not previously recognized by his colleagues. Now, however, because of the APA ceremony, "I feel prouder of his service," she said.

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