CONTENTS OF THIS ISSUE
Spring 2016 Issue |
 PRINT PAGE |
Book Review:
US Army Psychiatry in the Vietnam War:
New Challenges in Extended Counter Insurgency Warfare
J. Edwin Nieves, MD, DFAPA
Virginia News Editor
 |
J. Edwin Nieves, MD, DFAPA |
The book, “US Army Psychiatry in the Vietnam War: New Challenges in Extended Counterinsurgency Warfare” by Dr. Norman ‘Mike’ Camp, US Army Medical Corps, Colonel, Retired, is published by Army Surgeon General/Borden Institute. It came out in 2015 and should be mandatory reading for any student of mental health and war. Published 40 years after the end of the Vietnam (VN) war, it documents how the social changes of the nation at the time impacted the Army at war in America’s first large-scale counterinsurgency conflict in decades.
This book covers not just the personal clinical experiences of Dr. Camp as an Army psychiatrist in Vietnam, but also expands to give the reader an indepth view of the historical background of the war and the cultural framework of Army service and Army psychiatry of the time.
The book grabs the reader from the start, setting the historical background of the country of Vietnam, its peoples, past conflicts, and the origins of the US policy involvement right up to military intervention. The narrative builds up the involvement of mental health services concurrent with the buildup of military forces in the country. Dr. Camp separates the first half of the war, the “good years” (my italics) 1965-1969, from the draw-down half, the “bad years” 1969-1973. The war becomes unpopular and dissent, demoralization, and substance use become more frequent; as a point-counterpoint of the war, a balancing act that will be prevalent throughout the book, these two periods are used to reference clinical and cultural environment in Vietnam as the war progresses.
The initial mission of military psychiatry at the beginning of the war is well laid out, with an overview of the military psychiatry “wartime mission”. It gives a very detailed account of the services available in the field right up to the evacuation hospital. In essence, the Army mental health services were the same as in prior wars, with a unit-based entry of care for a soldier with mental health symptoms. Initially, a soldier would be treated locally with support, rest, symptomatic management, and with the expectation that he would return to his unit in a short period of time, say, two to three days. This task would usually be performed by a field medic, who had some military mental health familiarity but not specialized training, and a general medical physician with access to first generation neuroleptic and anxiolytic medications. If the soldier did not improve in a short period of time, he would be transferred to the second level of care. This would still be within the soldiers “operational” zone but better staffed with psychiatrists, social workers, psychology/social work enlisted technicians, and broader treatment alternatives. Again, if the soldier did not improve in this clinical environment, referral to a tertiary level of care, i.e. an evacuation hospital with a specialized psychiatric treatment unit, would be made. Throughout the book, firsthand, researched and anecdotal clinical vignettes give the reader a very clear view of the practice of psychiatry in Vietnam. Here Dr. Camp also uses the two periods of the war to separate the case presentations. These are excellent and provide the clinical reader a very human “over the shoulder view” connection to the Army psychiatrist and his patients at the time. The reader can sense the anxiety army psychiatrists must have felt when faced with some of their referrals. They were tasked with seeing soldiers that sometimes were simply afraid or felt disconnected (and unprotected) by their unit because of the one year rotation system. Several of the case vignettes are more reflecting of fear, anger, predisposing vulnerabilities, (e.g., premorbid character pathology) and combat avoidance, than a diagnosable and treatment-requiring mental health illness.
The presentation of the various cultural angles of the war, aspects which are not clearly seen in movies or TV specials but critical in my opinion, is the main contribution of the book to the discipline. Vietnam service proved to be a counterinsurgency euphemistically called “low intensity conflict”, where there were no set front lines. It was characterized by unpredictable, short, intense engagements alternating with long periods of “boredom” and the relative safety of returning to base camp. No terrain was held, and the “body count” strategy (attrition) took a psychological toll on soldiers. The war also had unique cultural nuances. The impact of the one year rotation system on the morale of the soldier, the lack of general public support for the war, and the concurrent social/civil revolution back in the “world”, greatly contributed to soldier stress (and to that of his psychiatrist).
Feeling unsupported by their country, these changes also gave birth to some of Vietnam’s unique lingo and other pertinent clinical cultural aspects of Vietnam war. The slippery slope of marijuana and heroin use in troops, the breakdown in discipline, racial tension of the time and how it transferred to units, the “fragging” (a process described in page 303), appearing later in the war, the lack of leadership by some (page 300) and the presence of leadership by others (page 55) keep the balancing act of the narrative. Era language, “overflight” (p. 40 and 78), “UUUU” (p. 259), “REMF” (p. 455-7), “juicers” (p. 329) and the book’s many candid photos, maps and graphs make it all the more interesting.
* Note: each chapter of the book can be downloaded for free as a .pdf file at the Army Surgeon General/Borden Institute website (www.bit.ly/vietnampsych)
About the Author:
Dr. Camp earned his medical degree from the University of Tennessee and trained in general psychiatry at Walter Reed Army Medical Center. He completed his fellowship in child and adolescent psychiatry at the Letterman Army Hospital. He served in the US Army Medical Corps in a variety of leadership positions (clinical, academic, and administrative), and geographic locations, retiring with the rank of Colonel. Dr. Camp served in Vietnam from October 1970-October 1971 as Commanding Officer of the 98th Neuropsychiatric Medical Specialty Detachment, earning a bronze star for meritorious service. Following his Army retirement in 1988, Dr. Camp took the position of Director of Resident Psychotherapy Training at the Medical College of Virginia/Virginia Commonwealth University (MCV/VCU) in Richmond, Virginia. He is currently Clinical Professor of Psychiatry and continues to teach and supervise psychiatry residents there. An account of Dr. Camp’s personal odyssey in writing this book can be found in a September 6, 2015, article in the Richmond Times Dispatch at http://bit.ly/lohmannrtd
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