In The Things They Carried, by Tim O’Brien he expresses what it was like to be in the Vietnam War. O’ Brien tells stories of what it was like during the war, and how the stress of the war affected him and his fellow soldiers. The stories that he tells relate to prevalent mental health issues that are common among soldiers, such as Post Traumatic Stress Disorder (PTSD). This disorder was widely ignored after the war, when soldiers needed the support and were let down by their country. This caused many soldiers conditions to get worse as they got older. In addition, leaving soldiers without treatment showed how far spread the disorder truly was. Looking at the way that O’Brien describes combat experience we can see, how that type of stress can translate into PTSD, which is important because O’Brien gives descriptions that help his readers understand the type of immense stress Vietnam soldiers were under during the war. 

Post-Traumatic Stress Disorder was not a recognized disorder in the DSM manual until 1980. The DSM is a nationally recognized manual for diagnosing mental illnesses. PTSD is a disorder where the subject becomes detached from their relationships, and can have panic attacks and other side effects. This disorder was added to the DSM manual due to a mixture of research about Holocaust, Vietnam Veterans, and sexual trauma victims. The current DSM criteria for PTSD includes, exposure to a traumatic event, and more specifically must meet; intrusion, avoidance, negative alterations in cognitions and mood, and alterations in activity. This is significant because in O’Brien’s book each soldier is exposed to these types of situations, and they are all prime candidates for PTSD. O’Brien describes the high stress situations that soldiers find themselves in, and research shows that combat soldiers are far more likely to have PTSD than any other soldier. 

An example of O’Brien showing soldiers with PTSD is when he speaks about what each soldier carries with them during the war. In addition to the mandatory things that the soldiers carried, each of them had things that had special meaning to them. One soldier, Norman Bowker carried the thumb of a young Vietcong Soldier with him. It was given to him by another soldier, when they found him at the bottom of a ditch. The description that O’Brien gives is very detailed and is enough to give the reader chills. The men were taking other things off the body of the enemy soldier, and Bowker wanted a reminder of how solemn he felt when they found the soldier. This type of stress that Bowker experienced is enough to have him meet criteria from the DSM manual. That one event is enough to put Bowker on the PTSD spectrum, let alone carrying around the soldiers thumb with him as a constant reminder of the deceased boy. O’Brien does a very nice job of describing the men’s actions so well that the reader can almost feel what it was like to be at war, and the type of stress that the soldiers were under. The types of tendencies O’Brien writes about show relation to PTSD even though the soldiers are still at war. It shows one of the pillars of PTSD, alteration of activity. 

Another example of how O’Brien shows how the soldiers in the stories are prime candidates for PTSD, is when he describes the many times their platoon went into combat. He describes a scene where the men lay completely still for fear of being seen by the Vietcong soldiers. The soldiers had to lay still for hours in this high stress situation where at any moment they could be killed. Each man in the story is thinking about what might happen to them, because they couldn’t do anything else. Studies have shown that combat is the main way soldiers become victims of PTSD, and O’Brien describes a prime situation where combat can induce PTSD (Thompson, 7). He goes further to describe the actions of his comrades after this high stress situation, saying that many had a change in behavior, a sign of PTSD. Each soldier’s behavior changes in a different way showing that PTSD can manifest itself in many different ways. This shows that O’Brien knew what it was like to be in these situations and how the stress of combat can form into PTSD, and may be writing from the perspective. This is an interesting point because mental health is such a large issue today, but when the veterans needed help with PTSD the most no one cared about their mental health. 

O’Brien also goes into great detail about one soldier in particular, Lieutenant Jimmy Cross. O’Brien speaks about how Lieutenant Cross carries a picture of a girl from home, whom he barely knows. In Lieutenant Cross’ mind he is in love with the women, when in reality she only sends him letters as a type of pity, to a lonely man in war. O’Brien basically does a profile of his Lieutenant and highlights all of the qualities that make Cross a candidate for PTSD, according to DSM criteria and other studies done. The author later describes when a soldier was killed in action because Lieutenant Cross wasn’t paying enough attention. Lieutenant Cross blames himself because the reason he didn’t do anything was because he couldn’t stop thinking about his girl from home. While in previous combat scenarios Lieutenant Cross had used the thought of the girl to stay calm and collected, this time the thought of her consumed him and took his focus away from what mattered. After the soldier’s death Lieutenant Cross blames himself, and can’t think of anything else besides his guilt and the blame, and it consumes him. It is this type of obsessive behavior that leads great soldiers to get severe PTSD. The Lieutenant was stressed and felt guilty, being in these high stress situations all of the time, and not having a proper outlet is a reason that leads soldiers to getting PTSD.

Surveys taken from one study suggest that combat is the main way for veterans to get PTSD is for them to go through stressful combat experience. One study shows that the percentage of veterans who were diagnosed with PTSD after coming home from Vietnam was grossly incorrect (Thompson, 1). Interestingly in another study the researchers came to a similar conclusion. They also saw that the number of soldiers that were originally diagnosed was vastly off, and the real percentage is somewhere around 20-50% (Motta,10).

Later in his book O’Brien tells a story of the time he killed a man during the war. He is telling the story to his daughter and you can tell as he is speaking to her that it is giving him stress to relive the memory. The way he tells the story he tells details made up details of the man’s life and what type of work the man may have done, and what he was like. While the man was a soldier for the Vietcong, O’Brien can’t get over that he was an ordinary man doing what he was told, just like he was. It pains O’Brien to tell the story and he never really specifies to his daughter that he was the one to kill this particular man. Instead he makes up another story about having killed someone when he threw a grenade. The daughter is shocked by this, the fact that her father had killed anyone at all, and is scared because she now thinks of her father in a different light than she did before.

This story and profile of O’Brien goes along with a study done showing how PTSD in soldiers affect them and their families. The strain of war was great on the families of veterans, because their loved one would come back very different than when they left for war. In most cases the veteran would come back very cold and detached, as well as they would avoid any talk about their time in Vietnam. These signs of PTSD would go unnoticed in families, and would get worse and worse until the veteran had severe PTSD. This would not only affect the veteran, but also their family. For example, when O’Brien tells this detailed story of killing a man, and then going on speculating about the man’s life, and his hopes and dreams, it puts stress on the daughter as well. She is unsure what to think about the war that her father was fighting and all she is hearing are the intense violent parts, that her father was in. This can cause mental health issues for others in the family who have to deal with their loved one coming back different, and the stress of hearing the violent stories from their loved one. 

Another way O’Brien gives examples of him and his men being susceptible to PTSD, is when he speaks about morals. The men are talking about a dead body they found, when one asked if it was moral to take things off of the man. Then another responds that there are no morals in war. This type of attitude, that nothing is off limits, and there is no right and wrong in war. Having this outlook on life gives the soldiers little hope, and makes them lose key social skills that are used in everyday civilian life. This creates a culture shock when the soldiers get back to the states, and can lead to PTSD, because the solders no longer understand how to socialize with civilians. Studies have shown that soldiers respond better to going back to civilian life when they are eased into it. Soldiers also feel useless when they return home from war, as O’Brien describes. They feel like they have no purpose and no control after being able to do whatever they wanted in Vietnam, to having to follow the rules of society and go back to a normal life. During the Vietnam War soldiers had even more problems because no one understood what was happening to the soldiers when they returned home, and since many people did not want to be in the war they were not welcoming when the soldiers got home either. 

Another interesting point made throughout the book is that none of these men are looked at for mental health issues during the war. They all just continue fighting the war, while symptoms of PTSD were manifesting in each of them. Examples of this can be found all over O’Brien’s text, like when O’Brien spends so much time describing what each man carries, he talks about not only what it is but every single detail of the item, and what it means. This type of obsessiveness can be a sign of mental distress. Another example is of another soldier Ted Lavender, who carried around drugs with him. This type of destructive behavior that Lavender participated in is a sign that he might have PTSD, and other mental disorders. In the text it is described that Lavender uses the drugs when he feels stressed as a way to escape from the realities of war. This shows that Lavender was, like many other characters in the book, a prime candidate for PTSD.

It is interesting that throughout the book O’Brien gives many example of how soldiers could have PTSD, but in many studies it is shown that soldiers don’t acquire severe PTSD until many years after the war has ended. In that study, it does include both combat and noncombat soldiers, which could skew the data. This analysis of soldiers with PTSD truly shows how intense the situations that O’Brien and his men were in, seeing as they all showed clear signs of PTSD. An example that can be analyzed is O’Brien’s obsessive ness about what each man carries, this type of behavior is an example of PTSD because he is trying to focus all his attention on something besides the war. This is an example of how a soldier can get PTSD before the war is over. Another example of a soldier getting PTSD during the war it Ted Lavenders drug use. Again, like O’Brien, he is using the drugs to help him forget he is at war and to calm himself down in stressful situations. 

Studies also show that soldiers who better remember the war have a greater chance of developing PTSD. Which may be a reason why O’Brien is such a good candidate to be a veteran with PTSD. O’Brien has such a great memory of the war, and the details that he uses to describe his time during the war are yet another indicator that he most likely has PTSD from his combat service. This is a significant study, because many veterans are asked by family and friends to tell stories of their time in the war, and their loved ones don’t realize how much it hurts the veteran, and can strain their mental health, to have to talk about and relive their war memories. This goes along with another study, previously mentioned, that shows that the higher rates of PTSD in veteran’s correlates with a higher rate of PTSD and other mental disorders in veteran’s families. This shows how each moment of a veteran’s life has a great impact on the veteran’s mental health. 

When O’Brien describes what each man carries he is not only describing the extra physical load each man carries, but also the symbolic weight that the men are carrying. Each man carries something because it has meaning to them, or their family. Studies have shown that soldiers with families at home are more likely to get PTSD and other mental health disorders because they have something to lose in the war. This reasoning shows through in O’Brien’s book, especially concerning a soldier named Kiowa. He carries with him a bible, and his father’s hatchet. Carrying an extra hatched is a large weight to carry, and Kiowa constantly has it with him. This type of constant reminder of family and loved ones is a distraction during war, and can make soldier unfocused during war, another way soldiers can acquire PTSD.

O’Brien’s book is very relevant to how PTSD and other mental disorders are dealt with today. Just as after the Vietnam War many people ignored mental disorders, and didn’t believe that soldiers were coming home with mental health issues and PTSD. Veterans were coming home and only being treated for their physical wounds, while their mental stability was depleting. While our society has made great strides for veterans with PTSD, we haven’t made strides for dealing with other mental health disorders. Focusing on PTSD and veterans, since the Vietnam War the Veterans Association has taken a stand on mental health care for Vietnam Veterans. They have fought for veterans to be better taken care of and for researchers to focus on the causes of PTSD, and preventative measures for veterans. In addition, the Veterans Association has also supplied care to Vietnam Veterans who without it would still be suffering from the horrors they faced during the Vietnam War. 

The study of PTSD is still relevant today, because the United States still has veterans who are coming home with symptoms of PTSD. The difference between the Vietnam War and now, is now doctors know how to treat PTSD. The disorder can be treated by a combination of counseling for the veteran, and medication that can help calm and clear the head of the veteran. These medical advancements made in the research of PTSD can be attributed to the Vietnam War, because so many soldiers came home with mental health issues, because of the gruesomeness of this particular war. The stories that O’Brien and many others told are the reason why the government took action and decided that PTSD was a worthy cause to research. Without veterans like O’Brien telling their stories, medical advancements in the field of psychology would be nowhere near as far as they are today.

To conclude, O’Brien’s stories of what it was like to fight in the Vietnam War, relate to prevalent mental health issues in America. He does this by describing many different soldiers and many different tendencies of the soldiers that can be seen as symptoms of PTSD. O’Brien does a very nice job of going through each soldier and describing different ways that each soldier is struggling during the war. While this disorder was ignored after the war, it is because of people like O’Brien that mental health disorders in veterans were researched. O’Brien’s combat experience shows his audience how stressful life in war is, and shows how hard it is for veterans to avoid PTSD, because of exuberant amounts of stress, and fear that the soldiers go through every day. 

Summary: In Epidemiology of PTSD in a National Cohort of Vietnam Veterans by Josefina J. Card she explores how one high school class of veterans were affected by their time in the war. Specifically, she looked at how their stress levels were, how there interact in social situations and how their mental health was. She also looked at some variables like environmental variables and what parts of the war the veterans were in. Her study based the definition of PTSD off of the American Psychiatric Association’s Diagnostic and Statistical Manual’s definition of the term. Her data concluded that heavy combat does lead to having PTSD, and can induce emotional distress in the veteran, and that a significantly higher number of veterans had PTSD than were originally reported in the study.
