GIVE YOURSELF the Great Rorschach Test of Vietnam. What comes to mind when you hear the words "Vietnam veteran"? Quite frankly, whether your reaction is anger, arrogance, sympathy or respect, chances are it is also filled with negative connotations. When we think Vietnam veterans, we think problems.
The problems of the Vietnam veteran have reached metaphorical heights. They receive broad media play. One's perspective on them often defines one's attitude about the war itself. Interpretation of them often goes beyond facts, causing those who served to become the symbol of what one would like to believe about the war itself. Not unlike Moby Dick, this has become more than a story about a whale.
On March 6, the prestigious New England Journal of Medicine published a "special article" entitled "Delayed Effects of the Military Draft on Mortality," replete with an accompanying editorial proclaiming that this "ingenious epidemiologic analysis . . . demonstrates the long-term excessive mortality of men who served in the military during the Vietnam war."
On that same day, an article in The Washington Post outlined this study under the headline "Viet-Era Draftee's Suicide Rate High." The article maintained that "military draftees who served during the Vietnam war era are as much as 86 percent more likely to die by suicide than their peers who did not serve and as much as 53 percent more likely to die in motor vehicle accidents." Dr. Norman Hearst, the chief among three co-authors of the study, was quoted as saying that "we are looking at an expression, a final, tragic expression, of the very serious long-term effects that this experience of being in Vietnam had."
The network evening news shows gave the study major play. CBS proclaimed that "the study documents for the first time that there is a cause and effect relationship between having served in the military during Vietnam and problems later, including suicide." NBC tied the story in with a recent double suicide in which a veteran who had never been to Vietnam and his girlfriend killed themselves and her three children "in protest over government treatment of Vietnam veterans," and mentioned the study as finding that "Vietnam veterans are 86 percent more likely" to commit suicide.
These reports matched the study's major conclusion, which stated that "before sending young men to war, especially one in which they may have experiences similar to those of Vietnam veterans, those who make the decision should weigh all the costs. The casualties of forced military service may not be limited to those that are counted on the battlefield."
Rather strange that a limited epidemiological study should result in a major conclusion of sweeping political dimension. But well and fair, except the study established nothing of the sort, even if one accepts its methodology, which is questionable and very likely flawed.
Among other limitations, the study dealt only with men born in three years, 1950 to 1952, who died in California and Pennsylvania between 1974 and 1983. It failed to identify any of those who had died specifically as a veteran or nonveteran. Its aggregate numbers did not count as veterans men born in those years who began serving in the military before they would have been screened by the draft lottery. It wrongly presumed that the socioeconomic bias against men who served was screened out of the study. It ignored the fact that very few of these men would have served in Vietnam.
And yet this examination of blind data has already been extrapolated and accepted by many who reported it. The study is "ingenious." In the news accounts it quickly is "found" to apply to all Vietnam veterans. It "demonstrates long-term excessive mortality of men who served in the military during the Vietnam war."
What it does demonstrate is that those who served in Vietnam indeed continue to have problems, but perhaps not the one envisioned by the study.
The real problem began in the 1960's with the debates about the war itself and continues because of our inability as a nation to assimilate that divisive experience. The affirmative public image of a nation's soldiers as basically good men involved in a just cause, and of the enemy's as somewhat less than good representing a cause to be defeated, has been a vital underpinning of virtually every war experience in history. One of the lingering and incredible ironies of the Vietnam war is that these two assumptions were reversed by many Americans, with the communist soldiers taking on the aura of "goodness" in a "just cause" while our own fighting men were sometimes subjected to the sort of propagandist ridicule normally reserved for enemy soldiers in other wars.
This defamation, which continues today in more subtle form, has been carried on with such viciousness and lack of regard for the truth that the typical veteran searches vainly to understand its depths. A starting point, however, is remembering that the United States went through an intellectual civil war during the Vietnam era, a war of values and ideas, and the men who fought the war were the most tangible reminders of the values and ideas the antiwar movement wished to defeat.
Thus, the allegations of an "immoral, genocidal war" often translated into "our soldiers are rapists and baby killers." Similarly, exhortations by antiwar leaders that the avoidance of the draft was just and honorable translated syllogistically into "military service is either dishonorable or stupid." That this logic permeated the more advantaged members of the age group and eventually polarized it along class lines is demonstrable in many ways. Harvard College graduated 12,595 men from 1962 to 1972, and lost 12 in the entire war. Princeton graduated 8,108 during that same period, and lost six. MIT graduated 8,998, losing two. By contrast, South Boston, Mass., which had perhaps 2,000 draft eligible males, suffered 25 men dead on the battlefields of Vietnam, and West Point lost 34 dead from the 579 men of the class of 1966 alone.
From about 1968, when the the war effort began to be discredited after the misperceived U.S. and South Vietnamese "loss" of the Tet offensive, until about 1978, when hundreds of thousands of Vietnamese began jumping into the sea in order to flee their "liberators," those who had not served could and often did perpetrate a moral and intellectual arrogance over those who had. As James Fallows, one of the very few of those who did not serve to have spoken honestly of the long-term implications of such a split in the age group, pointed out several years ago in the Atlantic Monthly, "to those who opposed the war, the ones who served were, first, animals and killers; then "suckers" who were trapped by the system, deserving pity but no respect; and finally invisible men . . . A returned veteran might win limited redemption if he publicly recanted, like a lapsed communist fingering his former associates before the HUAC. Otherwise, he was expected to keep his experiences to himself."
One would think that the brutal aftermath of the communist takeover in 1975, with its continuing expansionism, bloodletting and Gulag mentality, would have mellowed some of the earlier antagonism. Whatever one's opposition to the Vietnam war or to its actual conduct (which deserves no prizes), it is clear that the stakes for which we fought were real. The loss of a country the size of Poland to a Stalinist regime tied strongly to the Soviet Union was a dreadful blow to the ideals our nation cherishes.
Unfortunately, however, the antagonism persists. A major reason relates to the ongoing debate over what Harrison Salisbury a few years ago termed "the mythology of the Vietnam war."
History's judgment is not yet firm as to why we failed in Vietnam. Was it because of the misplaced idealism, indeed the frequent naivete of those who opposed the war, which gave sustenance to our enemy? Was it because of failed political policy? Was it because of the impact of the media on our national morale? Was it because our soldiers simply could not defeat their soldiers? Or all of the above or maybe none? The lines seem still to be drawn, although the arguments are more carefully muted than fifteen years ago. And in many ways the symbolic center of mass in this debate is the pursuance of the war by, and its impact on, the veteran who fought it.
One reaction, perhaps intentional and perhaps subliminal, has been to continue to degrade the veterans' experience and its later impact on those who served so that the experience itself loses its credibility in the debate, except on negative terms. This is the 1980s version of what James Fallows described as the veteran's alternative in the 1970s: Recant or shut up.
And so we see a tendency to ignore the good news accompanied by a compulsion to broadcast loudly the bad. Examples are voluminous. A few:
The man who fought in Vietnam is typically depicted as a draftee, unwilling and probably black. In fact, two-thirds of those who served during the era were volunteers, 73 percent of those who died were volunteers and 12.5 percent of those who died were black (out of an age group that comprised 13.5 percent of the male population).
While readjustment problems were great for many, (as was true in World War II, where the National Academy of Sciences estimated 25 percent of returning soldiers had emotional difficulties upon return), this is the first war where the problems rather than the successes have become the dominant theme in the media. No responsible Vietnam veteran would wish to diminish the difficulties encountered by many of his comrades, and it is a lasting credit to those who served that the impetus for the treatment of the approximately 20 percent who experienced readjustment difficulties came from within the veterans' community. What upsets Vietnam veterans is not the attention given to those who have been less fortunate, but that their plight is the unwarranted symbol of the entire peer group. For instance:
In the most comprehensive survey of Vietnam veteran attitudes ever done (1980, Harris Survey), 91 percent of those who served indicated they were "glad they served their country," 74 percent stated they "enjoyed their time in the service," 80 percent disagreed with the statement "the United States took unfair advantage of me," and 72 percent agreed strongly with the statement "The trouble in Vietnam was that our troops were asked to fight in a war which our political leaders in Washington would not let them win." The media response to this survey was almost total silence.
Similarly, during March, 1985, a Washington Post/ABC news poll conducted a random sample of Vietnam veterans, "precise to within a 4 percentage point margin," which indicated that Vietnam veterans were more likely to have gone to college, more likely to own a home and more likely to earn $30,000 a year or more than others in their age group. A majority of the veterans interviewed felt they had benefited from being in Vietnam, supported the bombing of the North and the use of napalm and did not seem bothered by the fact that others avoided military service. The Post, it must be said, reported this survey fairly. No one else seems to have picked it up. One needn't wonder what would have happened if the story had indicated otherwise.
Dozens of features, both in print and visual media, have focused on Vietnam veterans in prison, the implication being that service in the war zone turned untold legions on to crime. To the contrary, the Bureau of Justice Statistics figures indicate that Vietnam veterans are less likely to be in prison than their nonveteran peers.
And now the New England Journal of Medicine study. The issue of veteran suicides has surfaced before. In 1978, the Carter administration issued a presidential memorandum which was widely circulated claiming that Vietnam veterans were 23 percent more likely than their nonveteran peers to commit suicide. A few months later, VA officials discovered that the statistic was erroneous, arrived at by projecting the suicide rate among hospitalized psychotic veterans onto the entire Vietnam veteran population. Nonetheless, the damage done was almost impossible to reverse.
The New England Journal study analyzed 14,145 men who were born in the years 1950 to 1952 and died in California and Pennsylvania between 1974 and 1983. These were the principal years of birth involved in the draft lottery system which came into effect in 1970, basing eligibility for conscription on a man's birthday. Birthdays were selected randomly under the lottery system, making some men eligible for the draft and some exempt.
The researchers broke the deceased down according to their birthdays and thus classified them as "draft eligible" or "draft exempt." The "draft eligible" pool showed showed a 4 percent higher death rate overall and a 13 percent higher suicide rate. The study did not determine the veteran status of any of the deceased. Rather, it presumed that 25.6 percent of the "draft eligibles" were conscripted and that 9.3 percent of the "draft exempts" volunteered. Quite obviously, it did not address whether a man had been in Vietnam.
The researchers claimed that the randomness of the lottery made it possible for them to eliminate other considerations regarding the cause of higher death and suicide rates, such as socioeconomic status or medical problems. They then concluded that the one distinction between the "draft eligible" and "draft exempt" groups was the effect of military service. Consequently, they attributed all of the excess mortality on the "draft eligible" side of the equation to the effects of military service on the 25.6 percent in the lotteries who were, in fact, drafted.
Thus, the 13 percent higher suicide rate for a whole group of unidentified draft eligibles translated into an 86 percent higher suicide rate among draftees who would have begun military service between 1971 to 1973. In the media (with a little help from Dr. Hearst) this conjecture suddenly covered all draftees in the Vietnam era, and then in a flash all Vietnam veterans -- all without a single veteran having been identified!
Curiously, the cause of death which showed the greatest difference between the two groups was cirrhosis of the liver -- the draft-eligibles were only 75 percent as likely to die from this ailment as the draft-exempts. If we had pushed this inconsistency through the same bottleneck as the suicides, the headlines might have read, "Viet Vets Much Less Likely to Die from Cirrhosis." The researchers dismissed this anomaly to "chance."
Despite the predictable media attention, there are numerous questions which must be addressed before one could take this study seriously. A few:
The lottery process was not purely a function of birthdates. In 1970, it included not only those born in 1950, but others born from 1945 to 1949 who previously had been exempt. In all three years, it excluded those who were already in the military, and others who were deferred or exempt for reasons other than date of birth.
The study presumed that only 9.3 percent of those who were not drafted ever served, which is the estimate for voluntary enlistments after the lottery. To the contrary, two thirds of the people who served in the military during the Vietnam era were volunteers. As an example of how this affects the study, Department of Defense historical data indicates that, by the time those born in 1952 became eligible for the lottery in 1972, 273,110 were already in the military. In contrast, only 43,706 from this year's group were drafted -- including 1,678 from the noneligible pool! The rather cavalier usage of rough aggregates, when subject to this sort of statistical bias, not only could affect the premises and analysis of the study, but also its rather macrocosmic conclusions.
The study recognizes that mortality tends to be higher among men of lower socioeconomic status, but claims that the randomness of the lottery eliminated this bias. Hardly. The lottery may have brought more of the advantaged elements in for physicals, but did nothing to eliminate what James Fallows termed "the loopholes in the physical qualification standards that, for college students armed with a doctor's letter and advice from the campus draft counseling center, could so easily be parlayed into the 'unfit for service' designation known as a 1-Y."
This socioeconomic bias not only is important when considering mortality rates, but quite often impacts on such things as the "coding" of deaths such as suicides. Those of higher socioeconomic status are frequently able, through legal and other means, to negotiate the suicides of family members into such categories as accidental deaths. The resons, in addition to questions of family stigma, also include important financial considerations such as insurance benefits. When it comes to coding, the poor commit suicide, while the rich merely die lonely, accidental deaths.
Very few of this group of conscriptees could have served in Vietnam, and particularly in combat. Hearst's assertion that the study measures the "serious long term effects that this experience of being in Vietnam had" is highly improbable. By late 1971, when these inductees would have first been eligible to serve in Vietnam, few would have been sent, and by the time the men of the other year groups were inducted it would have been almost impossible. Our combat role had almost ended by late 1971 (387 soldiers died in the last six months of 1971, 172 in all of 1972), and was completely ended by January, 1973.
The "case control" study which allegedly validates the major study may actually invalidate it.
Since 1979, Pennsylvania has required a notation of veteran status to be included in death certificates. For 2,003 of the men in the major study, this status was known. Those who conducted the study examined these numbers and claimed that the breakdown among these men verified the major study. Twenty percent of the veteran deaths, and 14.7 percent of the nonveteran deaths, were suicides.
But only 26 percent of the total Pennsylvania deaths were veterans, while 33 percent of the population in the age group are veterans. This means that the overall Pennsylvania death rate among veterans was lower than nonveterans, and inflates one particular cause of death -- suicides -- that appears constant between veterans and nonveterans. One-third (32.8 percent) of the total suicide deaths were veterans, 30.7 percent of motor vehicle accident deaths were veterans, and 31 percent of deaths from cirrhosis were veterans. The major distinction was in the largest category, deaths by "other causes" (such as long-term disease), where only 22.9 percent were veterans. This fits with the historic notion that veterans are less "unhealthy" than their nonveteran peers, since those with serious medical problems are screened from service.
What drives such macrocosmic political conclusions from such a tenuous examination of data? One is tempted to take a hint from the study itself. In the opening paragraphs, the three doctors mentioned that "men of low socioeconomic status . . . may be less adept at avoiding military service." Perhaps in the wake of the Vietnam war, men of high socioeconomic status should talk less about avoidance as a goal and more about the dignity and importance of military service.
The failure to ratify this principle for Vietnam veterans has been the biggest problem, from whence all others have derived.