Studying the Vietnam War, in association with The Things They Carried, lays a foundation for understanding the lack of care U.S soldiers receive when returning home from modern wars. In Tim O’Brien’s historical fiction novel, he details the everyday lives of soldiers as they navigate personal struggles at home and abroad. Post-Vietnam was the first time in United States history that as many soldiers were returning home with mental illnesses as physical ones. The dissatisfaction for the war back home only compounded veteran’s issues, because funding for returning soldiers was next to impossible. This lack of care in both diagnosis and treatment for a variety of issues that returning veterans faced, can be seen as the beginning of the modern health care crisis for returning soldiers from wars. The story illustrates the specific horrors and struggles that a Vietnam warrior dealt with. In examining The Things They Carried, returning soldiers’ accounts of care they received, and records about their treatment it illustrates how the system of care for veterans was broken after Vietnam and has not been fixed. 

The most iconic illness for soldiers returning from Vietnam was Post Traumatic Stress Disorder, or PTSD. The mental illness was not diagnosed in its modern form until 1980. Its addition to the Diagnostic and Statistical Manual for Psychiatric Disorders (DSM), which is the chief mental illness catalog that is updated every year, only came after serious pressure on the medical community to explain the widespread mental issues many returning veterans were having. PTSD is described by the presence of acute or long-term symptoms of traumatic flashbacks, bad dreams, paranoia, and irrational fear (Department of VA). For Vietnam veterans, and others returning from war, their worst memories from war become an everyday reality. According to the National Vietnam Veteran’s Readjustment Survey, about 30% of male soldiers experienced the disease sometime in their life, and about 27% of their female counterparts experienced the same (Department of the VA). The treatments for PTSD are as wide ranging as the symptoms. In modern medicine, various anti-depressants, known to help with symptoms of the illness, are used.  But, more importantly, therapies and support groups have proven to be the most effective way to treat the disease (Kiing). Today, various support groups for veterans are available and provided by non-profit organizations, most notably the Wounded Warrior Project. The access to drugs and intense psychological care, however, are much harder to come by for veterans who cannot afford top of the line health care. 

The Vietnam War, because of new technology and warfare tactics, was the most graphically violent war fought at the time. Napalm, agent orange, and destructive guerilla warfare were unseen before Vietnam (Bickerman). All of these aspects created scenes for soldiers that left a lasting mark. The National Institute for Mental Health has identified ten contributing factors to contracting PTSD, and ten resisting factors (NIMH). These contributing factors include: loud explosions, violence, death, illness, exposure to factors for significant lengths of time, and lack of treatment in short-term. All of these factors are present in Vietnam, and are an important reason why so many in Vietnam developed PTSD. When reading about the graphic details of this war, in The Things They Carried, it is not hard to find numerous examples. These are kids thrust into a foreign country with the job to kill an enemy they know nothing about. As said best from this passage in The Things They Carried, "He was a slim, dead, almost dainty young man of about twenty. He lay with one leg bent beneath him, his jaw in his throat, his face neither expressive nor inexpressive. One eye was shut. The other was a star-shaped hole.” (O’Brien). The eyes and bodies of those they killed through explosive measures surely haunted many long after their time in Vietnam ended. Agent orange and Napalm burned its opponent in mass quantities, leaving nothing in its wake (Bickerman). Hardly traditional warfare, this style of killing is proven to leave a mark on anyone who witnessed it, far more than battle with lines of soldiers and an unwritten ethics agreement to not torture. It is fair to concede that no war is pretty, but no modern war could be described as more destructive on a soldier’s entire life than Vietnam. 

Anxiety disorders and serious depression, which led to widespread addiction, also ravished departing veterans from Vietnam. As seen in The Things They Carried, most soldiers were prescribed some sort of medication in order to suppress fear and other emotions that would limit a man’s ability to fight (O’Brien). Almost 15% of soldiers became reliant on some sort of amphetamine or codeine prescription in the war (Department of VA). These anti-stimulants were prescribed in doses by the military, at three to four times the rate for civilians (Bickerman). This short sighted approach by the United States military did reduce the rate of mental breakdowns two-fold, compared to Korea and World War Two, but left hundreds of thousands of soldiers in debilitating shape when they returned home (Bickerman). Back at home, without the aid of mind numbing drugs, soldiers returned crippled with anxiety, depression, and addiction at much higher rates than civilians (Department of VA). The two main drugs of choice were heroin and alcohol, which only accelerated the symptoms of depression and anxiety for many returning home. Since the average age of a returning soldier was only twenty-four, these illnesses had lifelong effects (Robbins). Thousands remain in poverty because of the depression and addiction that has taken over their lives, because of supposedly “harmless” treatments to them during their time as service men and women. Just as in the case with PTSD, there are many great organizations and charities that provide grants and funds to send troubled warriors to treatment facilities for their addiction. These organizations have helped many, but countless others have been left behind to recapture their life alone, while fighting an uphill battle to receive medical care from Veteran’s affairs. 

After analyzing the novel in a historical context, it sheds new light on what the US Government cared about in regards to its soldiers. “In addition to the three standard weapons – the M-60, M-16, and M-70 – they carried whatever seemed appropriate as a means of killing or staying alive” (O’Brien). Tim O’Brien’s novel goes into specific detail in these lines, and throughout the book, about different weapons and killing methods, but leaves out any such details about intensive mental care for its soldiers in battle. With war comes a certain level of violence and trauma that can be expected, but, with the amount of resources poured into Defense spending (well over 45% of the United States Budget per the Department of VA), we need to account for our soldiers at home and abroad more effectively than just arming them with better guns. Until the level of attention for mental health is on par with the attention of detail of outfitting soldiers with weapons, there will be extreme flaws within the VA. “They carried all they could bear, and then some, including a silent awe for the terrible power of the things they carried” (O’Brien). This quote from The Things They Carried is important because it highlights that, no matter what training you put these soldiers through, they will not be prepared for the realness of war. This demonstrates how much care for mental health is needed from the battlefield all the way home.

The main issues surrounding the VA after Vietnam were mainly: lack of knowledge and effort to study mental illness more. The breadth of volunteer organizations we have available today was also not there during this time. Many organizations such as; the Wounded Warrior Project, No Man Left Behind, and Veterans War Associations were not formed until after 2003, when the Department of VA officially supported non-profits (Department of VA). Without non-profits driving for causes to be funded, many veterans were left without a voice. The money that did make it through the VA, was restructured from Defense Department spending to reconstruct hospitals and conduct research for amputations (Department of VA) (Kiing).  The failure here was that, despite the amount of medical advances being made on physical injuries, there was not enough money going into mental research. This is a main issue for the hundreds of thousands returning home with an undiagnosed illness known now as PTSD. If there had been more effort put into researching what was plaguing many soldiers overseas, they would have been able to make a diagnosis and proper treatment quicker.

The other issue many returning soldiers faced, was the realization that they were not considered heroes. From the outset, many Americans were skeptical about the mission of the conflict, and were less than welcoming to those that decided to fight in it (Bickerman).  This apathy toward the war was the main reason for the lack of help returning soldiers received. What legislators, and the head of the Veteran’s department failed to realize, was that with the amount mentally and physically ill people that were returning back home, it would require an effort by the entire population to appropriately care for these people. Soldiers reported feeling isolated and alienated by civilians upon their return (Robbins). This was a far cry from the hero’s welcome that their World War Two counter parts received. In The Things They Carried, Martha, a pen pal of Jimmy Cross, seems almost oblivious to the perilous situation that her friend is in; a sentiment that many people back home felt. Despite the scenes of the war that played out daily on nighttime television news, the people of America felt a lack of responsibility to care for heroes because of personal opinions about the legitimacy of the war. The feeling of a lack of responsibility to care for veterans started in this very moment, and has hampered the development of a proper veteran’s care unit, all the way into treating soldiers from Afghanistan in 2016. 

The modern day VA is still one of the most contested government agencies. Criticisms range from: lack of care, to waiting for treatment and proper medicine for over a year. The majority of these failures can be seen developing in the years immediately following Vietnam as well. Even within The Things They Carried, the steps toward failure for care can be seen. Despite heavy combat description in the book, there is no primary care shown for persons showing mental difficulties. “Lieutenant Cross felt the pain. He blamed himself.” (O’Brien). These descriptions about the Lieutenant are obvious signs of PTSD and Depression (NIHM). The lack of care shown here in the field, demonstrates the same apathy shown towards veterans when they are done with their tour of duty. This is important because it is the fundamental reason why the VA continues to fail many veteran’s returning home, even in 2016. Over one hundred billion dollars was budgeted to the VA in 2016, in mandatory spending alone (Department of VA). The department has been funded with over fifty billion each year since 2000 (Department of VA). Despite these quite healthy budgets, over 300,000 veterans a year waited for more than 6 months for primary care in 2015 alone (Kine). This is because, what many modern veterans suffer from is mental illness. Twenty-seven percent, which is just about the same as Vietnam, suffer from a mental disease, which as described before, take time and more than a prescription to fix (Kline). Instead of dollars, the VA needs to invest time and effort into spending time with all of its veterans to have tailored plans, instead of trying to fit everyone into prescriptions. 

When analyzing the Department of the VA’s budget since Vietnam, it is clear the main goal is to strictly save lives. A recent study showed that, over three-quarters of the budget went to medical equipment specifically engineered to reduce casualties, such as, better heart sensor tools and other imaging scanners. The mad dash to strictly save lives is an important one that must remain; but when over half of soldiers (NIHM) are diagnosed with some form of mental illness, and only twenty-five percent of a one hundred-billion-dollar budget is going toward treating the most expensive and extensive type of illnesses, there is a problem. More so than just money, what is needed is a major overhaul in the mindset of every American toward returning troops. Everyone has a role to play to re-acclimate a modern soldier to civilian life. The wars from Vietnam to now are different than anything seen in history. They are more violent, and the weapons could not be more destructive to watch. The returning veterans must be cared for differently than anything has in history, and it starts at the ground level with every citizen.

The experiences of soldier in Vietnam is comparable to that of a modern day soldier. Gone are the days of fronts, lines, and trenches, and welcome to never knowing who or where the enemy is on a given day. In The Things They Carried, soldiers accounts are the baseline for what to expect going forward in modern day war. “If a mission seemed especially hazardous they carried everything they could. In certain heavily mined AOs where the land was dense with Toe Poppers and Bouncing Betties, they turn humping a 28-pound mine detector” (O’Brien). No war before had these hidden killers, but every war after has become increasingly silent. Many plights of Vietnam are the benchmark for similar struggles experienced in modern day wars. Napalm has been replaced by drone strikes, as the primary source of civilian casualties, but the message has remained the same. These destructive measures wear on a soldier, and it is evident that struggles have only worsened for modern day soldiers. Suicide rates are sky high for troops returning home since 2002, and are double what the civilian rate is at 30.2 per 100,000, compared to just 14.7 for civilians (Department of VA). This is an interesting point, because it suggests that mental health is still very far behind curbing the immense problems that veterans have when returning home. The United States over the course of the war in Vietnam became desensitized to the harshness of war. This is important because, it cements Vietnam’s place as the starting point for not only the issues in veteran’s care, but for the reasons for having to change the entire way that we care for returning soldiers. The war was certainly difficult, and was handled improperly, but for the most part, the same questions are continually asked when America when involved in a conflict: why are we here? How can we care for our veterans better? The truth is that, both of these questions are equally important, but must be dealt with separately. This matters because, the utmost care should always be rewarded to an American veteran, simply because of the extreme trauma they have gone through. Vietnam changed Americans by making them ask the why question, long before asking how to better care. Until this changes, the United States will always be behind on caring for its veterans.

In 2016, war is as contentious as ever; with every decision our government makes under a more intense microscope. According to the Department of Defense, over two and a half million troops were deployed in Iraq and Afghanistan, with about a third of those people becoming disabled veterans from combat injuries or mental health problems. With similar disability percentages to the Vietnam War, but without the casualty numbers, (6,000 total in Iraq and Afghanistan compared to 55,000 in Vietnam per the Department of Defense) the VA will have a great number of returning soldiers that need extensive mental care. The next ten years when troops return in large numbers will be the largest group of soldiers needing care since the disaster that was Vietnam; and will provide a good example to see if the United States is actually ready to handle returning veterans and all of the care that they need. 

The outcomes of the Vietnam War have placed the United States in an immense hole when it comes to caring for and treating the mental health problems of its returning soldiers. When researching systemic problems in mental health care for veterans, alongside Tom O’Brian’s novel The Things They Carried, it revealed many issues that arose in Vietnam and evolved into long-term issues that carry into the USA today. PTSD, depression, anxiety, and addiction affected Vietnam War veterans worse than any conflict in American history. A short – sighted approach, and a lack of research, led to many failures to take care of human beings fighting for our country in Vietnam, and domestically when they returned. It will take the effort of an entire nation to rebuild decades of stigma associated with returning veterans with psychiatric issues, all initiating during, and immediately, following Vietnam. 
