Introduction
Importance of American veteran reintegration into society
The effects of wars may be mass destructive and unpredictable for different societies. On the one hand, not many people can forget what happened to them on the battlefield and continue their lives without thinking about losses and challenges they had to experience. On the other hand, a number of physical injuries and traumas can change ordinary human lives. War outcomes are usually divided into short- and long-term and veterans can cope with them independently or with the help of specialized organizations and communities.
Nowadays, post-traumatic stress disorder (PTSD) and combat-related disabilities turn out to be the two significant public health concerns that undergo a considerable increase from political, governmental, healthcare, and social perspectives. Each war has its reasons, development, and outcomes. The shadow of the Civil War, as well as the Vietnam War, is dark and tricky. Both war periods generated many casualties that resulted in the creation of a new population of disabled veterans who had to integrate their lives with those of people who did not see the war directly.
Military conflict choice
It does not matter what type of war a person participated in, new transformations, explanations, and evaluations were required because a person had to learn how to live a new life with no experience and knowledge about it. Sometimes, veterans are not able to take the necessary steps and begin their new lives. Not all of them are aware of the existing health care and nursing benefits believing that only service-connected disability rating matters.
Medical and mental health treatment is usually offered to everyone who asks for help even if a person was neither wounded nor injured on the battlefield. This paper will focus on the examination of the effects of American veterans with disabilities and PTSD concerns in the shadow of the Civil War and the associated treatment to be offered to veterans as juxtaposed against the current backdrop of the modern era wars moving forward the post-Vietnam period through discussing the peculiarities of mental health problems, treatment approaches, offered congressional policy changes, and VA response to the epidemic of disability claims and employment.
Mental Health Problems among Veterans: The Civil War vs. Modern Post-Vietnam War Era
It is wrong to neglect the fact that the American Civil War did not bring any psychological disorders and behavioral changes. It was impossible to witness deaths of comrades, multiple fires, and harsh injuries and stay the same. Civil War soldiers got multiple scars that gained “the forms of death, maiming, and the destruction of property”. Different mental health problems were observed among the veterans of the Civil War. The most frequent disease was post-traumatic stress disorder. In fact, such diagnosis as PTSD was first officially developed in the 1970s and used to cover the condition of Vietnam War veterans at that time. However, the analysis of symptoms and effects on human behavior proves that this disorder bothered many veterans before the Vietnam War, including the Civil War of the 1800s.
Its symptoms included a constant experience of actual harm, the presence of real or imaginary threats to be harmed physically or emotionally, multiple disturbing dreams and memories, and the inability to accept changes. It was hard for people to identify where real and imaginary events took place.
As a result, wrong behaviors, misjudgments, and unfair treatment were developed. Jacob Mendez Da Costa was one of the first American cardiologists who observed the symptoms of PTSD among soldiers and veterans and called it “Da Costa’s syndrome” investigating people with “shortness of breath, rapid pulse, and fatigue” during the time of stress with fear being involved. Society had to take some actions in order to prove their care of veterans and recognize their contributions to social development. With time, PTSD was identified as a public health concern that had to be solved. Still, it was not the only problem.
The outcomes of the American Civil War gained different forms and outcomes. For example, Anderson and Anderson identified a significant revival of nostalgia and explained it as a “mental disorder that had created problems for armies for centuries”. This disorder was characterized by “anorexia, insomnia, slow fever, irritability, anxiety, and a general wasting aware of the organism”. As a rule, two types of soldiers were exposed to this disorder: young people who developed unbelievable imaginary skills and married men who experienced family absence for the first time. Nostalgia did not only create some challenges and problems.
It could kill on the battlefield the same way a shot or a bomb did it. Similar results were observed among veterans who had to come back home without the ability to forget what they saw during the wartime. Though it was another type of nostalgia, meaning unintentional but casual, it was present and had certain outcomes for people.
It is also necessary to admit that many Civil War veterans, as well as the participants of the Vietnam War and the Modern Era wars, had serious brain complications caused by different traumas. Traumatic Brain Injury (TBI) and amnesia were frequent among veterans. For example, some soldiers described their condition as if they “they’d taken my brain out… and passed it around and played with it”.
There are many ways in which it was possible to describe the outcomes of wars. Sometimes, people were ready for injuries and harm as they were aware of what they agreed to and what they were fighting for. However, compared to the Civil War, weapons used during the Vietnam War and other modern-era wars were characterized by a rather devastating nature, including newer aircraft, bombers, and even the use of chemicals.
Much attention should be paid to the impact of chemical weapons during wars and their impact on future veterans. In the Civil War, only gas chambers were used for particular people. During World War II, its participants demonstrated a considerable growth of theoretical and experimental physics that was able to pertain to atomic energy and promote the discovery of nuclear fission. After that war, many countries found it necessary to prepare themselves for chemical attacks and realize the level of chemical power of the enemy. In the Vietnam War, chemicals like Agent Orange were used to damage the environment and cause new health problems.
As a result, if Civil War veterans were exposed to emotional and psychological traumas based on their imagination and evaluations only, and the veterans of the Vietnam War and other modern-era wars were unwillingly exposed to chemical attacks the goal of which was to promote new mental health problems and increase complications that were hard to treat.
The outcomes of such wars as the Vietnam War touched upon a number of psychological factors that promoted the development of mental health problems. First, many people faced the fact that they and their actions had been forgotten in a short period of time. Their intentions to protect the native land and support the ideas of civil freedoms were not appreciated and resulted in unstable and dangerous behaviors. Much stress, warfare confusion, and pain deprived veterans of a chance to control their aggression.
In comparison to the Civil War that was popular and well-recognized around the whole world due to its clear goals and contributions, the Vietnam War and other later wars were not popular. Many American lives were identified as poorly explained and week sacrifices made by the government. Vietnam War veterans were deprived of specific values and beliefs. They did not realize why the price of this war was so high.
The results of such misunderstandings could be observed through stress disorders and mental problems which were hard to control. To be successful and fully understood by citizens, wars should have a goal and rationale in terms of which all actions and political decisions can be interpreted. For example, Napoleon used military reforms and technological progress to motivate his followers and protect soldiers. The Civil War was the war for independence and the possibility to gain new power and strength. The First and Second World Wars showed how important the qualities of good leaders were in terms of decision making, the development of supply lines, and even the discovery of oil products through wartime.
The Vietnam War was caused by a belief that communism could be a threat to American society. This reason was not properly proved or explained. People had to be involved in the war and complete their social duties and responsibilities. All these misunderstandings, blind following of rules, and a devotion to an unclear national idea led to new psychological and emotional challenges.
In addition, mental health problems were increased because of the impossibility to discuss them with someone else. No one could understand warfare experience and all those outcomes. Veterans were obliged to re-integrate into a society that was not ready to accept veterans with all their concerns, needs, and expectations. The personal experience of many soldiers shows that not all veterans are usually prepared for communication with their families and friends after the war. “As all of his friends, family, and neighbors peppered him with questions about his experiences in the army, he noticed that he was not happy”, and instead of “talking and laughing with his friends, his mind would suddenly revert to the times, places, and scenes in the South”.
Not all people are ready to understand how to behave with those who survived the war. Sometimes, instead of support and understanding, patience or orders can be important. Unprepared communities and families cannot cooperate with veterans and should address additional professional help. However, time to come to such conclusions is hard to control, and mental health problems may grow fast.
Medical Treatment Available to Veterans
The presence of mental problems was evident after each war. Despite the fact that the number and scope of disabilities and veterans’ concerns differed at different war periods, medical treatment and health care had to be offered to their fullest possible extent. The end of the Civil War was characterized by millions of deaths because of combat injuries or fast-developing diseases. There were also thousands of civilian and military people who were in need of long-term care and support. However, only the supporters of the Union side were able to receive free medical help, and Confederate soldiers got refusal until the governmental changes of 1958.
Unfortunately, it was not always possible to understand when people could ask for help, and when medical treatment and assessment were not available. Cox explains that treatment may be equally revealed only when “the body is the center of public policy debates but removed from the eye of the crowd”. In other words, society wants to know what people can get, the government tries to take steps and offer help. As soon as less attention is paid to the same problem, its solution may be postponed. Though such an approach is unfair and harsh, it is wrong to neglect this possibility.
Still, the most dangerous thing many veterans faced could be identified through the comparison of medical and health care offered to people after the Vietnam War and the Civil War. Civil War veterans returned home as heroes for their society. The Vietnam War did not have similar outcomes, and veterans were deprived of many things, including trust, honor, and even medical treatment.
However, despite personal and governmental attitudes developed after wars, people were in need of professional and effective mental health help. Treatment had to be offered to all people, and the methods of treatment for PTSD or other associated disorders varied widely at different periods. Compared to the Civil War where professional medical help was offered only after the battles in special facilities, the Vietnam War was the period when more attention was paid to the condition of soldiers on the battlefields. Certain military techniques of mental health treatment were developed to promote “proximity, immediacy, and expectancy” proving that “elite units have lower rates of psychiatric breakdown”. Though psychological reactions to war and their outcomes were considerably shifted after the Vietnam War, military psychiatry continued gaining popularity.
In general, an associated treatment that followed wars at different periods was characterized by such factors as the level of knowledge about the possible diagnosis (PTSD was not officially recognized during the Civil War but was accepted as a serious problem after the Vietnam War), attitudes to veterans (Civil War veterans were heroes, and Vietnam War veterans were not honored), and readiness to help and solve mental health problem (during the Civil War, first medial attempts were formally marked, and during the Vietnam War, new experience was gained).
To offer appropriate treatment for military veterans with PTSD and other after-war disorders, it was necessary to identify all associated co-morbidities, including depression, anxiety, substance abuse (discovered in more than 70% of Vietnam veterans), alcohol/drug disorders, and pain syndromes. Regarding these factors, treatment was divided into pharmacological and non-pharmacological, depending on social functioning and treatment adherence.
As a rule, the Department of Defense and the Department of Veterans Affairs (VA) were responsible for the development of special treatment guidelines and standards available to veterans. The period of the Civil War was marked as the time when the first mental health help was offered. There were three main sources of help: family, community, and governmental programs that presupposed the creation of special soldier homes and appropriate pension systems.
Though all these facilities did not address the solution of mental health problems directly, they helped to identified psychological challenged or disabled veterans and developed new methods of financial and moral compensation. Non-pharmacological treatment for Civil War veterans with the signs of PTSD and other mental disabilities was based on the use of different psychological interventions. The main therapies included cognitive behavioral therapy, cognitive processing therapy, and prolonged exposure therapy. Each therapy had an effect on veterans and their styles of life after the war.
For example, cognitive processing therapy was developed to investigate the impact of trauma on veterans. Medical experts focused on patients’ abilities to identify negative memories, clarify a related event, and understand why the chosen event caused stress in order to replace all these thoughts and add new associations. Prolonged exposure therapy was used to help veterans experience similar traumas or negative events under different conditions.
Patients had to experience the same event in a safe, clinical setting and learn how not to be afraid of the outcomes and use gained knowledge and skills to achieve another final. PTSD concerns among civilian and combat-related cases could also be solved with the help of eye-movement desensitization and reprocessing therapies during which a patient had to reprocess traumatic information until it was not psychologically disruptive. All these methods were used to support all veterans with the only difference: Civil War veterans could receive help despite their impact on the war, and Vietnam veterans faced numerous misunderstandings and some kind of social hostility.
In some cases, veterans were not able to respond to non-drug therapy in a proper way. They could not deal with their negative memories and emotions and had to address medications or combine non-pharmacological therapies with drug therapies. Antidepressants were the main solution for many Vietnam veterans because the government did not want to focus on the development of special non-pharmacological programs but spend less time to demonstrate their care for veterans.
Changing diversity was a burning issue not only in political affairs but also in health care and post-war medical treatment. Hostile attitudes and unwillingness to spend on care for veterans whose impact has doubtfully defined the quality and scope of mental health treatment. On the one hand, such inhibitors as sertraline and paroxetine were approved by the Food and Drug Administration to treat veterans, and only 20% of patients achieved the desired remission. On the other hand, the inability to combine different therapies to achieve positive results or offer a second-line therapy proved the existing veteran concerns.
Alternative ways to treat veterans after different wars were developed regarding the activities of special governmental organizations like the VA. In addition to the creation of new acts and laws to support veterans and define their role in American history, it was necessary to identify possible resources of employment and other types of social support. These steps could be used to understand the options of American veterans with PTSD and other mental disabilities and the readiness of the government and society to support veterans and recognize the true sacrifices of soldiers.
Congressional Policy Changes
The promotion of treatment for disabled or PTSD-challenged veterans directly depends on how well governmental bodies understand their duties and responsibilities. The decisions of the presidents are not the only factors that can determine the quality of care. US strategic culture, health care, and social support are as closely connected to the presidency, as to work of the Congress and Senate. Therefore, congressional policy changes and improvements cannot be ignored in the discussion of treatment offered to veterans regardless of the chosen period.
Health care and hospitalization of veterans were not properly discussed by the US government prior to World War I. Only a few disabled veterans were able to receive legally approved help and treatment. The Veterans Bureau, as well as the Veterans Administration, was officially founded at the beginning of the 20th century. These organizations took responsibility for all veterans’ affairs, including health care. However, those small still significant steps taken by President Lincoln in the 19th century deserve attention and recognition.
One of the main achievements in health care services was the creation of special homes and reforms to support disabled people. For example, in 1834, the Naval Asylum was created in Philadelphia were all veterans could receive help and support without considerable time limitations. In 20 years, another care home was opened. It was the National Soldiers’ Home in Washington, DC. Though the names of these facilities were changed with time, their essence and impact remained the same. Till 1958, Confederate veterans did not receive any benefits, but Congress gave its forgiveness to all people to destroy this diversity.
To provide veterans with care, Congress made a decision to stabilize their pensions and financial support required for health care. In 1862, the General Pension Act was introduced to promote disability pension for all veterans, and in 1873, it was improved through the Consolidation Act and a number of aid programs. In 1865, another remarkable facility was founded. The National Asylum for Disabled Volunteer Soldiers was opened with a number of branches the goal of which was to offer incidental medical care for disabled veterans despite their problems.
If the congressional policy changes after the Civil War were directed to introduce effective care and define the rights for free medical treatment, the period of Vietnam and the post-Vietnam war was characterized by limited benefits and a larger percentage of disabled veterans. There were two main reasons why congressional policy challenges were required at that time. First, many veterans experienced hostile attitudes of the civil population due to the weak causes of the Vietnam War. Second, the presence of chemical weapons aggravated the situation with the growth of serious mental health problems and physical disabilities.
It was necessary for the Congress to compensate expenses on health care and to divide care in regards to injuries. Servicemen’s Group Life Insurance was the program for Vietnam veterans to cover their losses. The only distinctive feature of the Vietnam War period was the intentions of the VA to divide its responsibilities with other commercial insurers, proving unstable attitudes to Vietnam veterans. In the middle of the 1970s, much attention was paid to the training of healthcare experts because the government had to be sure that in case of veterans asked for help, they could get it.
In 1979, the Veterans Health Care Amendments Act was signed to promote the establishment of medical centers for veterans around the whole country, and in 1991 the Agent Orange Act was introduced to cover free follow-on hospital care for people who suffered from Agent Orange attacks. In addition to direct care for veterans, Congress investigated the conditions under which veterans’ children who could suffer from mental disorders received specialized care and help. In other words, instead of thinking about new opportunities for veterans, the government tried to create acts to explain their limitations.
Veterans Administration’s Response to Disability Claims and Employment
The US Department of Veterans Affairs is a well-known governmental body the goal of which is to provide all American veterans with affordable healthcare services and other social support that may be required as soon as people live battlefields and have to continue living their normal lives. Though it was found at the beginning of the 1900s, it is wrong to discuss its effects and outcomes of veterans’ affairs after the Civil War.
At that period of time, no particular organization was created with the only purpose to respond to disability claims, employment conditions, and other problems that were identified among the population. During the 19th century, the US population depended on the decisions made by different governmental bodies and specialized organizations which promoted the creation of care homes, asylums, and other facilities. Congress took responsibility for providing special working conditions for veterans with disabilities, and special commissions were created to clarify which spheres could be appropriate for veterans regarding their abilities and disabilities.
As soon as veterans received a required portion of treatment, they were given the list of professions to be occupied with. Much attention was paid to occupations where one arm or leg only was enough for effective work as such traumas were frequent among Civil War veterans. Employment and health care were integral issues among disabled people. Though the Veterans Administration did not demonstrate its clear response due to its non-existence at that period, it was clear that society was ready and able to help veterans and offer them good opportunities even if people had some disabilities and mental health disorders.
The situation after the Vietnam War differed for veterans from the one after the Civil War. First, it is necessary to admit that the VA was responsible for employment and caring for veterans. Clear goals and opportunities were discussed. It was also possible to gather statistical data and understand that the current economic recession led to the fact that a large number of veterans were unemployed. They did not receive compensations, and not many companies were willing to offer them jobs because of a low level of knowledge, poor experience, and unstable behaviors.
Therefore, the VA was obliged to develop new programs in terms of which veterans could develop their skills, learn new information, and use their theoretical experience practically. As a result, multiple training programs were introduced to disabled people. Some courses were supported by the VA only. In some cases, this governmental organization invited new commercial bodies to support veterans and promote social development and growth of the country. At the period of economic instability and uncertainty, it was expected that new figures could change the situation and promote stable employment.
Regarding existing programs, new opportunities, and the work of different governmental bodies, it was believed that most men and women who participated in fights and battles during the Vietnam War got similar access to employment as other people who did not serve. However, personal experience and direct communication with military people could prove certain inequalities and challenges in the labor market. Vietnam experience had its negative trace, and even the response of the VA was not enough to hide its impact on social life.
Conclusion
In summary, it is wrong to neglect the fact that American veterans, whether they survived the Civil War in the 19th century or the Vietnam War in the 20th century, had to deal with a number of disabilities, mental health problems, and challenges. The effects of their concerns in the shadow of war periods defined treatment they could receive. Though there was no Veterans Administration to solve the problems of Civil War veterans, the work of the Congress and the intentions to offer healthcare services proved governmental respect and care. In comparison to the Civil War, the Vietnam War brought a number of disappointments and misunderstandings. Being the representatives of different epochs, veterans suffered from similar mental disorders, physical disabilities, and emotional changes.
The main task of the VA was not only to establish enough care homes and facilities for veterans but also to prove that the government recognized the achievements and contributions made by soldiers and their families. Unfortunately, the experience of Vietnam veterans proved that not all military decisions could be supported and understood. Health care was not enough to cover human losses and negative memories.
The Civil War was the cause of many veterans being disabled emotionally and physically, and despite limited resources and poor technological achievements, the country was ready to support its soldiers. In general, medical treatment available to veterans of the Civil War and veterans of the Vietnam War differed in terms of moral and social support and understanding but was similar in terms of accessibility and governmental attention.
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