Mary Ellen was a nine-year-old girl from New York, who was being severally abused and neglected by her foster parents. Mary Ellen might have died if it wasn't for a social worker by the name of Etta Angell Wheeler, who was working in her neighborhood. The reality of what happened is frightening, Back in 1874 there were NO laws on the books to protect children, yet there were laws on the books to protect animals.
The social worker who knew Mary Ellen did every thing in her power to help. If it wasn't for this nurses determination we might not have the laws on our books that we have today. Etta Angell Wheeler did NOT sit back and do nothing. She responded. She didn't take NO for an answer. The solution to Mary Ellen's plight came because it was determined that she was considered a member of the animal kingdom. The Society of Prevention of Cruelty to Animal was then able to get involved and do something to protect Mary Ellen from any more harm.
When the Mary Ellen's story hit the news media there was a public outcry for there to be change in the way children were treated. The Society for the Prevention of Cruelty to Children was formed, by 1900 there were 161 such groups in the U.S.
It's unbelieveable that it wasn't until 1968, when Dr. C. Henry Kempe and Ray E. Helfer's book The Battered Child was published, that people began to be aware of and believe that parents and caregivers truly could and did physically abuse their children. Please note that it wasn't until almost 20 years later that the world started to pay attention to the whole issue of sexual abuse/assault of children (and adults).
Be aware it wasn't until 1983-84, in Illinois the Confidentiality of Statements Made to Rape Crisis Personnel granted absolute privilege to sexual assault victims. This act was important because it meant that anything a rape victim said to a Rape Crisis Counselor or Legal advocate was absolutely confidential. This meant that no court could supena records of victims.
In 1984 several very important acts were also implemented. In Illinois, the Violent Crime Victims Assistance Act was signed into law. This basically provided victims of all crimes, including survivors of sexual violence free counseling and advocacy. This same year the federal governement, signed into law the Victims of Crime Act (VOCA), it was at that time states received notice of future funding for victims services.
It's important to keep all of the relatively new history of how our society has dealt with criminal sexual acts. It helps to understand why it is so important for organizations like The Awareness Center to exsist.
We all have to be thankful to social worker - Etta Angell Wheeler, who cared enough to do something about Mary Ellen, back in 1874.
The Real Story of Mary Ellen Wilson
http://www.americanhumane.org/site/PageServer?pagename=wh_mission_maryellen
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| Mary Ellen Wilson |
The sufferings of the little girl, Mary Ellen, led to the founding of the New York Society for the Prevention of Cruelty to Children, the first organization of its kind, in 1874. In 1877, the New York SPCC and several Societies for the Prevention of Cruelty to Animals from throughout the country joined together to form the American Humane Association.
The following is Mary Ellen's story, which marked the beginning of a world-wide crusade to save children. It is extracted from American Humane's Helping in Child Protective Services: A Competency-Based Casework Handbook.
Over the years, in the re-telling of Mary Ellen Wilson's story, myth has often been confused with fact. Some of the inaccuracies stem from colorful but erroneous journalism, others from simple misunderstanding of the facts, and still others from the complex history of the child protection movement in the United States and Great Britain and its link to the animal welfare movement. While it is true that Henry Bergh, president of the American Society of the Prevention of Cruelty to Animals (ASPCA), was instrumental in ensuring Mary Ellen's removal from an abusive home, it is not true that her attorney—who also worked for the ASPCA—argued that she deserved help because she was "a member of the animal kingdom."
The real story—which can be pieced together from court documents, newspaper articles, and personal accounts—is quite compelling, and it illustrates the impact that a caring and committed individual can have on the life of a child.
Mary Ellen Wilson was born in 1864 to Francis and Thomas Wilson of New York City. Soon thereafter, Thomas died, and his widow took a job. No longer able to stay at home and care for her infant daughter, Francis boarded Mary Ellen (a common practice at the time) with a woman named Mary Score. As Francis's economic situation deteriorated, she slipped further into poverty, falling behind in payments for and missing visits with her daughter. As a result, Mary Score turned two-year-old Mary Ellen over to the city's Department of Charities.
The Department made a decision that would have grave consequences for little Mary Ellen; it placed her illegally, without proper documentation of the relationship, and with inadequate oversight in the home of Mary and Thomas McCormack, who claimed to be the child's biological father. In an eerie repetition of events, Thomas died shortly thereafter. His widow married Francis Connolly, and the new family moved to a tenement on West 41st Street.
Mary McCormack Connolly badly mistreated Mary Ellen, and neighbors in the apartment building were aware of the child's plight. The Connollys soon moved to another tenement, but in 1874, one of their original neighbors asked Etta Angell Wheeler, a caring Methodist mission worker who visited the impoverished residents of the tenements regularly, to check on the child. At the new address, Etta encountered a chronically ill and homebound tenant, Mary Smitt, who confirmed that she often heard the cries of a child across the hall. Under the pretext of asking for help for Mrs. Smitt, Etta Wheeler introduced herself to Mary Connolly. She saw Mary Ellen's condition for herself. The 10-year-old appeared dirty and thin, was dressed in threadbare clothing, and had bruises and scars along her bare arms and legs. Ms. Wheeler began to explore how to seek legal redress and protection for Mary Ellen. Click here to read Etta Wheeler's account of Mary Ellen.
At that time, some jurisdictions in the United States had laws that prohibited excessive physical discipline of children. New York, in fact, had a law that permitted the state to remove children who were neglected by their caregivers. Based on their interpretation of the laws and Mary Ellen's circumstances, however, New York City authorities were reluctant to intervene. Etta Wheeler continued her efforts to rescue Mary Ellen and, after much deliberation, turned to Henry Bergh, a leader of the animal humane movement in the United States and founder of the American Society for the Prevention of Cruelty to Animals (ASPCA). It was Ms. Wheeler's niece who convinced her to contact Mr. Bergh by stating, "You are so troubled over that abused child, why not go to Mr. Bergh? She is a little animal surely" (p. 3 Wheeler in Watkins).
Ms. Wheeler located several neighbors who were willing to testify to the mistreatment of the child and brought written documentation to Mr. Bergh. At a subsequent court hearing, Mr. Bergh stated that his action was "that of a human citizen," clarifying that he was not acting in his official capacity as president of the NYSPCA. He emphasized that he was "determined within the framework of the law to prevent the frequent cruelties practiced on children" (Mary Ellen, April 10, 1976, p. 8 in Watkins, 1990). After reviewing the documentation collected by Etta Wheeler, Mr. Bergh sent an NYSPCA investigator (who posed as a census worker to gain entrance to Mary Ellen's home) to verify the allegations. Elbridge T. Gerry, an ASPCA attorney, prepared a petition to remove Mary Ellen from her home so she could testify to her mistreatment before a judge. Mr. Bergh took action as a private citizen who was concerned about the humane treatment of a child. It was his role as president of the NYSPCA and his ties to the legal system and the press, however, that bring about Mary Ellen's rescue and the movement for a formalized child protection system.
Recognizing the value of public opinion and awareness in furthering the cause of the humane movement, Henry Bergh contacted New York Times reporters who took an interest in the case and attended the hearings. Thus, there were detailed newspaper accounts that described Mary Ellen's appalling physical condition. When she was taken before Judge Lawrence, she was dressed in ragged clothing, was bruised all over her body and had a gash over her left eye and on her cheek where Mary Connelly had struck her with a pair of scissors. On April 10, 1874, Mary Ellen testified:
"My father and mother are both dead. I don't know how old I am. I have no recollection of a time when I did not live with the Connollys. .... Mamma has been in the habit of whipping and beating me almost every day. She used to whip me with a twisted whip—a raw hide. The whip always left a black and blue mark on my body. I have now the black and blue marks on my head which were made by mamma, and also a cut on the left side of my forehead which was made by a pair of scissors. She struck me with the scissors and cut me; I have no recollection of ever having been kissed by any one—have never been kissed by mamma. I have never been taken on my mamma's lap and caressed or petted. I never dared to speak to anybody, because if I did I would get whipped.... I do not know for what I was whipped—mamma never said anything to me when she whipped me. I do not want to go back to live with mamma, because she beats me so. I have no recollection ever being on the street in my life" Mary Ellen, April 10, 1874 in Watkins, 1990).
In response, Judge Lawrence immediately issued a writ de homine replagiando, provided for by Section 65 of the Habeas Corpus Act, to bring Mary Ellen under court control.
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| Mary Ellen Wilson |
The newspapers also provided extensive coverage of the caregiver Mary Connolly's trial, raising public awareness and helping to inspire various agencies and organizations to advocate for the enforcement of laws that would rescue and protect abused children (Watkins, 1990). On April 21, 1874, Mary Connolly was found guilty of felonious assault and was sentenced to one year of hard labor in the penitentiary (Watkins, 1990).
Less well known but as compelling as the details of her rescue, is the rest of Mary Ellen's story. Etta Wheeler continued to play an important role in the child's life. Family correspondence and other accounts reveal that the court placed Mary Ellen in an institutional shelter for adolescent girls. Believing this to be an inappropriate setting for the 10-year-old, Ms. Wheeler intervened. Judge Lawrence gave her permission to place the child with her own mother, Sally Angell, in northern New York. When Ms. Angell died, Etta Wheeler's youngest sister, Elizabeth, and her husband Darius Spencer, raised Mary Ellen. By all accounts, her life with the Spencer family was stable and nurturing.
At the age of 24, Mary Ellen married a widower and had two daughters—Etta, named after Etta Wheeler, and Florence. Later, she became a foster mother to a young girl named Eunice. Etta and Florence both became teachers; Eunice was a businesswoman. Mary Ellen's children and grandchildren described her as gentle and not much of a disciplinarian. Reportedly, she lived in relative anonymity and rarely spoke with her family about her early years of abuse. In 1913, however, she agreed to attend the American Humane Association's national conference in Rochester, NY, with Etta Wheeler, her long-time advocate. Ms. Wheeler was a guest speaker at the conference. Her keynote address, "The Story of Mary Ellen which started the Child Saving Crusade Throughout the World" was published by the American Humane Association. Mary Ellen died in 1956 at the age of 92.
History of the Illinois Coalition Against Sexual Assault (ICASA)100 North 16th Street, Springfield, IL 62703
(217) 753-4117
http://www.icasa.org/icasaHistory.asp
In early 1977, women activists from nine community-based rape crisis centers in Illinois gathered to "form a mutual support group...adding strength to any issue such as legislative action, and giving our strength to each other." Searching for a name that reflected the profound social struggle necessary to end the degradation and rape of women, these activists named their group the Illinois Coalition of Women Against Rape (ICWAR).
As early as 1972, rape crisis workers in Illinois had established 24-hour crisis lines, conducted education and training programs, created thousands of brochures, offered self defense classes, organized and marched in "Take Back the Night" events and devoted thousands of hours to helping victims heal from the devastation of rape.
By linking their efforts through ICWAR, these early workers began their long journey to change the society. Like their sisters across the nation, coalition members advocated for legislative reform, insisted that police increase their arrest rates, demanded privacy for rape victims in emergency rooms and urged prosecutors to change plea negotiation procedures.
This monumental work, which forever changed the fundamental ways in which men related to women, was done primarily by volunteers. Rape crisis centers had very few resources other than dedicated activists. There was no formal education or professional training regarding how to do anti-rape work. However, once survivors broke the silence about the terror of rape, women devoted their minds, hearts, time and money to construct and sustain organizations that created the field of anti-rape work. These organizations changed practices in hospitals, police departments, the courts and within the field of psychiatry.
ICWAR received much support as it began its efforts. YWCAs, churches, synagogues, the National Organization for Women, women's studies programs, the American Association of University Women, United Ways and others pitched in with funds, space and staff time. Several state's attorneys and legal aid lawyers helped advocates sharpen their advocacy skills. And, the Illinois House Rape Study Committee forged political alliances to pass legislative proposals responsive to the needs of survivors.
Victims and their advocates created rape crisis centers to fill a void – with a definition and purpose different than traditional mental health or social services. With the goals of social change, equality between men and women, and the fundamental principle of victim-centered services, the anti-rape movement offered a new model for institutional change and individual healing. In Illinois, this model gained recognition and credibility with each new accomplishment.
ICWAR had multiple occasions to celebrate legislative victories. The Rape Victims Emergency Treatment Act standardized the collection of medical evidence. The Rape Shield Law made the victim's sexual history irrelevant in a trial. The Illinois Criminal Sexual Assault Act overhauled sex crime statutes. Federal and state statutes authorized new categories of victim service funds.
The first funding for sexual assault crisis centers, $148,889, was distributed by ICWAR to 12 centers in 1982.Later that year, four more centers were funded. Subsequent funds enabled centers to hire advocates, counselors and educators. Since 1982, centers have developed specialized services to meet the needs of children, adult survivors of child sexual abuse, teens and male victims. They have standardized volunteer training and developed curricula for conducting education and training programs. They have implemented protocols with hospitals and law enforcement agencies.
ICWAR changed its name to the Illinois Coalition Against Sexual Assault (ICASA) in 1984 and, with its many colleagues and supporters, continued to change the way the state responded to rape. Also in 1984, passage of the Illinois Violent Crime Victims Assistance Act made funds available for increased counseling and advocacy with victims of sexual assault. On the federal level, the Victims of Crime Act (VOCA) passed Congress, promising future funding for victim services. In 1986, ICASA received its first allocation of federal VOCA funds from the Illinois Criminal Justice Information Authority. Rape crisis centers hired full-time advocates and 16 centers established specialized counseling services for children.
Victim rights continued to receive a boost in 1994 when the Violence Against Women Act was passed by Congress and signed into law. Two years later, ICASA received its first VAWA funding from the Illinois Department of Public Health and the Illinois Criminal Justice Authority.
ICASA's funding increased from $6 million in 1996 to $13 million in 2000. The increase in funding has allowed ICASA member centers to greatly expand services to victims across the state. ICASA consists of 29 sexual assault crisis centers, which operate 26 full-time satellite offices. Member centers offer services in 73 of 102 counties in Illinois.
Throughthe coalition, the centers adopted standards for local centers and created a governance structure to allocate funds, track contract compliance, and provide technical assistance to help centers maintain services in their communities. ICASA continues to work on the cutting edge of legislative reform and to advocate for social change and the elimination of the oppressions that promote sexual violence.
- 1975 Rape Victims Emergency Treatment Act passes the Illinois General Assembly and is signed into law.
- 1977 Illinois Coalition of Women Against Rape (ICWAR) is formed.
- 1978 Rape Shield Act becomes law for sexual assault victims in Illinois.
- 1981 Federal Preventive Health and Health Services Block Grant is signed into law. Illinois Department of Public Health receives allocation with designation for Rape Crisis and Rape Prevention.
- 1982 ICWAR receives first Preventive Health and Health Services Block Grant allocation of $148,889. ICWAR creates its first Contracts Review Committee and allocates funds to twelve centers.
- 1983 Illinois Criminal Sexual Assault Act is signed into law, revising Illinois rape and incest statutes.
- 1983-84 Confidentiality of Statements Made to Rape Crisis Personnel grants absolute privilege to sexual assault victims.
- 1984 Illinois Violent Crime Victims Assistance Act is signed into law, making funds available for counseling and advocacy.
- 1984 ICWAR changes its name to the Illinois Coalition Against Sexual Assault (ICASA).
- 1984 Victims of Crime Act (VOCA) passes Congress; states receive notice of future funding for victim services.
- 1985 ICASA receives one-time grant from the Illinois Department of Public Aid for counseling services.
- 1985 ICASA granted its first allocation of state General Revenue Funds.
- 1986 ICASA receives its first allocation of federal VOCA funds from the Illinois Criminal Justice Information Authority.
- 1988 Law is passed prohibiting polygraph examination of sexual assault victims.
- 1988 Hearsay Exception is granted to child sexual assault victims under the age of 13.
- 1991 Civil Statute of Limitations for Adult Survivors of Child Sexual Abuse becomes law.
- 1992 Citizens vote "yes" for the Illinois Constitutional Amendment for Victims Rights.
- 1994 ICASA receives allocation for the SACY Project from the Illinois Department of Children and Family Services.
- 1994 The Violence Against Women Act is passed by Congress and signed into law.
- 1996 ICASA receives VAWA funding from the Illinois Department of Public Health and the Illinois Criminal Justice Information Authority.
- 1997 Sex Offender Management Board created by Illinois General Assembly.
- 1997 Law is passed allowing a defendant's previous victims to testify about defendant's "prior bad acts," whether reported or not.
- 1997 ICASA celebrates its 20th Anniversary with friends and colleagues.
- 1998 Law is passed which makes giving a person a "date rape drug" before sexually assaulting her/him an aggravating factor to the crime.
- 1998 ICASA and DHS, using VAWA funds, develop a media campaign that includes television and radio spots directed at male responsibility for rape.
- 1999 ICASA, with DHS, begins evaluation of its crisis intervention services.
- 1999 Law is passed to extend the criminal statue of limitations in sexual assault cases of an adult victim to ten years past the time of the rape and ten years past the age of 18 for minor victims.
- 1999 ICASA moves into a newly constructed administrative office building at 100 N. 16th Street in Springfield.
- 1999 Law is passed creating pilot Sexual Assault Nurse Examiner programs in four Illinois hospitals.
- 1999 ICASA, with VAWA funding, begins a two year evaluation of its prevention education programs in Illinois schools.
- 1999 Law is passed that allows a victim of sexual assault or sexual abuse to request that the State's Attorney file a petition to have the court records of the case sealed.
- 2000 Law is passed permitting minor sexual assault victims 13 through 17 years to consent to the release of her or his evidence collection kit to be analyzed for evidence for prosecution.
History of the terms Post-traumatic Stress, Rape Trauma Syndrome and Dissocation
Our Hearts and Our Hopes are Turned to Peace
CommunityWorks - Philadelphia, Pa., USA
http://www.istss.org/What/history.htm
Published in the International Handbook of Human Response to Trauma (2000), New York: Kluwer Academic/Plenum Publishers. Edited by Arieh Y. Shalev, Rachel Yehuda and Alexander C. McFarlane.
"Our hearts and our hopes are turned to peace as we assemble here in the East Room this morning", said President Johnson on the morning of November 1968. "All our efforts are being bent in its pursuit. But in this company we hear again, in our minds, the sound of distant battles".
President Johnson was addressing these words to those gathered for the Medal of Honor ceremony in honor of five heroes of the undeclared war in Vietnam. One of those heroes was a young African-American man from Detroit, Sgt. Dwight Johnson. Dwight, or "Skip" to his family and friends, had always been a good kid, an Explorer Scout and an altar boy, who could only recall losing control of his temper once in his life, when his little brother was being beaten by older boys.
But in Vietnam, when the men whose lives he had shared for eleven months, were burned to death before his eyes, he suddenly became a savage soldier, killing five to twenty enemy soldiers in the space of half an hour.
At one point, he came face to face with a Vietnamese soldier who squeezed the trigger on his weapon aimed point blank at Skip. The gun misfired and Skip killed him. But, according to the psychiatrist that saw him several years later, it was this soldier's face that continued to haunt him.
After receiving the Medal of Honor, Skip who had been unable to even get a job as a simple veteran, became a nationally celebrated hero. But his body and mind started to give way.
In September of 1970 he was sent to Valley Forge Army Hospital where the psychiatrist there diagnosed him with depression caused by post-Vietnam adjustment problems. "Since coming home from Vietnam the subject has had bad dreams", read the psychiatric report, "He didn't confide in his mother or wife, but entertained a lot of moral judgement as to what had happened at Dakto. Why had he been ordered to switch tanks the night before? Why was he spared and not the others? He experienced guilt about his survival. He wondered if he was sane" (Nordheimer, 1971).
On April 30, 1971, Dwight Johnson, now married and the father of a little boy, was shot and killed while attempting an armed robbery of a Detroit grocery store. The store owner told the police, "I first hit him with two bullets but he just stood there, with the gun in his hand, and said, 'I'm going to kill you . . .' I kept pulling the trigger until my gun was empty".
In the exchange, Dwight Johnson, an experienced combat soldier, never fired a shot. His mother's words echo down to us, twenty-seven years later, "Sometimes I wonder if Skip tired of this life and needed someone else to pull the trigger" (Nordheimer, 1971).
It is with this dramatic behavioral reenactment of one young, despairing African-American soldier that the curtain opens on the first act of the story of the International Society for Traumatic Stress Studies. The ISTSS is one organizational part of a late twentieth century social movement aimed at raising consciousness about the roots of violence by enacting and reacting to that violence everywhere.
The ISTSS was born out of the clashing ideologies that became so well articulated in the 1960's and 1970's. War crimes, war protests and war babies; child abuse, incest and women's liberation; burning monks, burning draft cards, and burning crosses; murdered college kids and show trials of accused radicals; kidnappings, terrorism and bombings; a citizenry betrayed by its government and mass protests in front of the Capitol in Washington - all play a role in the backgrounds of the people who founded the organization and in the evolution of the organization itself.
If I have learned anything from my contact with victims of violence, I have learned that it is vitally important to remember - and honor - the lessons of the past. We have to know where we came from if we are to know who we are now.
But it is extremely difficult to write history as history is being made. Since this chapter can only serve as a marker along the way, I have chosen to concentrate my attention on the origins of the Society, before those roots become even more lost in the darkness that envelopes those who move offstage. There are two fundamental aspects of the growth of this group.
First, there are the individuals who provided the action - both the victims and their advocates. One remarkable aspect of our history is the extent to which the founding mothers and fathers have had personal experience with trauma, as pointed out by van der Kolk, Weisaeth, and Van der Hart (1996).
It may be that it was this close brush with the Angel of Death that has given the growing field such a continuing sense of passion, devotion and commitment. Whatever the case, there are a multitude of stories begging to be told, severely limited here by time and space. The second aspect of organizational growth is the group-as-a-whole growth that I hope will emerge in the structure of the chapter.
The origins can not be placed at the foot of one powerful individual and did not derive from a clearly thought-out, hierarchical, managerial demand. Instead, it has grown organically, from the grassroots, and has remained multidisciplinary, multinational and multi-opinioned.
Dr. Chaim Shatan was familiar with the symptoms of war. His father had fought in three - the Russo-Japanese War, the Balkan Wars, and the First World War before moving from Poland to Canada. His father wrote short stories about his war experiences and the son translated them from Yiddish to English.
Shatan had gone to medical school during World War II, when physicians still received training in combat-related disorders and had evaluated men suffering from the traumatic neuroses of war (Scott, 1993). A New Yorker, Shatan read the New York Times routinely and when he read the story about Dwight Johnson, he felt compelled to respond. And, as co-director of the postdoctoral psychoanalytic training clinic at New York University, he could even harbor hope that it would get published.
His op-ed piece to the New York Times was published in May, 1972 and titled, Post-Vietnam Syndrome. In his editorial, Shatan described what came to be called post-traumatic stress disorder, and told how he had noticed these symptoms in the Vietnam veterans he and his colleagues had been seeing in "group rap" sessions (Shatan, 1972; 1978a).
One of these colleagues that Shatan referred to was Robert Lifton. Lifton was an ardent antiwar activist who had served in Korea as a military psychiatrist and had already studied and written about the survivors of Hiroshima (Lifton, 1967). Lifton met Sarah Haley through the New York and Boston chapters of the group, Vietnam Veterans Against the War (V.V.A.W.).
Sarah Haley was a social worker at the Boston Veterans Administration Hospital. Unlike most of her colleagues at the time, Haley recognized that many of her patients who had served in Vietnam, were being misdiagnosed as paranoid schizophrenics or character disorders because mental health professionals were failing to recognize the symptoms related to combat. But she knew them.
She had grown up with a father who was a veteran of World War II, a special agent for the O.S.S. and an alcoholic. She had heard stories of trauma and wartime atrocities from the time she was a little girl and she had personally experienced the long-term impact of war on her father's behavior. What other colleagues found unbelievable, she found entirely realistic.
When she met a Vietnam veteran who claimed to have been involved in the massacre of a village called My Lai, she believed him. It was through Haley that Lifton met and interviewed that soldier (Scott, 1993).
In January 1970, Lifton testified to a Senate subcommittee about the brutalization of GIs in Vietnam, a brutalization that he believed "made massacres like My Lai inevitable" (Lifton, 1973, p.17). In April 1970, the U.S. invaded Cambodia and students across the country rose up in protest.
Within days, the Ohio National Guard fired into a crowd at Kent State, killing four students and wounding nine others. Chaim Shatan had previously arranged for Lifton to speak at N.Y.U. but they decided to change the topic to address the Cambodian invasion and the Kent State killings, and advertised it widely around New York City.
Many people came who were not students, including some Vietnam veterans who were members of the V.V.A.W. (Scott, 1993). The rap groups in New York evolved from this meeting and from correspondence and phone calls between Jan Crumb, then president of the Vietnam Veterans Against the War, and Lifton, beginning in November, 1970 (Lifton, 1973).
When the clinicians sat down with Jan Crumb and several others from V.V.A.W., the vets described the way the members "rapped" with each other about the war, American society and their own lives and how they felt they would like some people around with greater psychological knowledge.
Lifton suggested they form more regular rap groups with some professional involvement. With the support of the chairman of the psychoanalytic training program at N.Y.U., Shatan circulated over three hundred memos asking for professional volunteers to join in their efforts. He urged them to help, telling them that "this is an opportunity to apply our professional expertise and anti-war sentiments to help some of those Americans who have suffered most from the war (Shatan, 1971).
He outlined for them three theoretical questions that he believed needed to be answered. What are the differences between Vietnam veterans and World War II veterans? Can we clarify the psychodynamics of war atrocities and demonstrate how they grow organically out of modern combat training? What is happening in the group process experience between veterans and professionals?
The enticements worked. Within five days, his memo had drawn forty volunteers. A panel of professional psychological and psychiatric colleagues in the New York area was formed. Most came from the New York University Postdoctoral Psychoanalytic Program, others from prestigious programs like the W. A. White Institute for Psychoanalysis and the New York Psychoanalytic Institute.
These clinicians participated in the groups until at least 1976 (Shatan, 1987). They called themselves "professionals" rather than "therapists" because they "had a sense of groping toward, or perhaps being caught up in, a new group form. Though far from clear about exactly what that form would be, we found ourselves responding to the general atmosphere by stressing informality and avoiding a medical model" (Lifton, 1973, p.77).
Word got out to the Vietnam vets through word of mouth, churches, and some media coverage and they started to come. Jack Smith and Arthur Egendorf, both veterans, were early members of the rap groups in New York.
In 1971, Shatan and Peter Bourne testified at the court martial of a Marine POW who was being charged with desertion, though he clearly suffered from traumatic stress. The papers written by Bourne and published in 1969 and 1971 about war neurosis were ignored.
The refusal to see the damage that had been done to these men motivated Shatan even further. The response to Shatan's op-ed article was overwhelming. He heard from over 1,250 rap groups from around the country as well as student health and financial aid offices on many campuses, and even veterans in prison.
Groups had already been meeting informally with psychiatrists in Philadelphia, Atlanta, and Boston (Shatan, 1987). All were functioning outside of the established VA services either because they were past the two-year limit for service-connected disabilities or because they found the traditional service, geared to World War II veterans, hostile to them and unwilling to meet their needs (Scott, 1993).
There was at this time, tremendous hostility towards the returning Vietnam veterans, particularly those who had become disillusioned with the war. And the hostility came from the left and the right sides of the political spectrum. John Kerry (now Senator John Kerry) was a founder of the V.V.A.W. and holder of three Purple Hearts, a Bronze Star, and a Silver Star for his service in Vietnam.
He reported that a Minnesota American Legion post excluded Vietnam vets because they had lost the war. Meanwhile, there were antiwar activists and pacifists calling the veterans "baby-killers" (Shatan, 1987).
Even the military victimized the vets as they were leaving the war through the practice of giving "bad discharge numbers". According to a discreet coding system, numbers were entered on discharge papers that identified veterans who had been seen as "troublemakers" while in the service, and then these codes were distributed to employers and personnel officers.
In the media, especially television, the stigmatization was furthered by the portrayal of Vietnam veterans as dangerous and psychotic freaks, murderers and rapists (Leventman, 1978). In 1978, Leventman, citing an earlier article of his own said, "nothing reflects so much of what is wrong with American society as its treatment of Vietnam veterans . . . one can only reiterate that the negative legacy of Vietnam lies more in civilian society than in the psyches of veterans" (p. 295).
In response to this discrimination, the veterans and their supporters organized a counter-VA consisting of therapeutic communes, storefront clinics, vet centers, and bars. They organized social and political protests. They conducted street theater with mock pacification operations in New Jersey villages.
In January of 1971, they organized war crime hearings called the "Winter Soldier Investigation" in Detroit, sponsored by Jane Fonda, among others. One hundred and fifteen veterans, as well as Robert Lifton, presented testimony about atrocities committed in Vietnam, while Fonda, and antiwar activist, Mark Lane, filmed the testimony and arranged for distribution.
Except for Life magazine, however, the event got very little national media coverage. In April 1971, the V.V.A.W. organized a march on Washington. The military had called the invasion of Cambodia and Laos, "Operation Dewey Canyon II, and the V.V.A.W. named their action "Operation Dewey Canyon III", designating it as a "limited incursion into the country of Congress". Their weeklong occupation of Washington culminated in a ceremony on the Capitol steps, a "medal turn-in" ceremony.
Jack Smith recalls, "I can still hear the dings of those medals, the Bronze Stars and the Silver Stars bouncing off the statue of John Marshall, and the Purple Hearts, behind the barricades" (Scott, 1993, p.23). They published an anthology of war poems and used the money to help a Quaker rehabilitation center in South Vietnam and to help rebuild Hanoi's foremost hospital, destroyed in the carpet-bombing.
They founded free clinics in poverty areas and staffed them with former nurses and medics. They offered legal aid and regular visits to vets in prison. And mental health professionals, moving beyond therapy and detachment to advocacy participated, "we went, with the vets, wherever we could be heard: to conventions, war crimes hearings, churches, Congress, the media, and abroad. We, too, suffered insomnia and had combat nightmares (Shatan, 1987, p.8).
Meanwhile, out on the West Coast, Dr. Philip May, a schizophrenia expert, was director of psychological services for the Brentwood Veterans Administration Hospital. in 1971. He recognized that Vietnam veterans were not getting the services they needed, so he hired Shad Meshad, a social worker and Vietnam vet himself, to evaluate the situation.
Meshad had already started one of the first rap groups in the country, in the Los Angeles area and was highly critical of the VA services. He had been a medic in Vietnam, was seriously wounded, and had endured several painful operations in the States. He knew what veterans were contending with from a first hand perspective (Meshad, 1997; Scott, 1993).
So did William Mahedy, who had served as a chaplain in Vietnam and was working as a social worker at Brentwood, "Most Brentwood psychiatrists that I met during this period had not the slightest clue how to deal with Vietnam veterans . . . they didn't know how to treat combat-related stress. Nor could they provide any guidance to the kind of total reintegration into society that we knew was necessary" (Mahedy, 1986, p.56).
In response, Meshad created the highly unconventional Vietnam Veteran Resocialization Unit within the Brentwood VA hospital, with the support of the director at Brentwood and set up storefront clinics where rap groups were held.
By 1973, Robert Lifton's book Home from the War was published, the first widely read book about the plight of the Vietnam veterans. He and Shatan had made strong and supportive connections with the American Orthopsychiatric Association and several universities. Both were impressed by the growing grassroots movement and believed that it could be strengthened even further.
In 1970, the National Council of Churches (NCC) had established an office under Reverend Richard Kilmer, an ordained Presbyterian minister, in order to help those hurt by the war in Vietnam. At first the NCC focused efforts on draft resisters and antiwar protestors, but in 1973, at the urging of Shatan and Lifton, the NCC began laying plans for the First National Conference on the Emotional Needs of Vietnam-Era Veterans.
According to Jack Smith, the veterans had pointed out to Reverend Kilmer that they had an obligation to minister to people who were in the war as well as out of it and the churches began to listen. The Missouri Synod of the Lutheran Church put up $80,000 for expenses and agreed to host the meeting at its seminary in St. Louis, appropriately situated right in the middle of the country.
Arthur Egendorf developed a list of veterans, psychiatrists and others who were actively involved in helping Vietnam veterans around the country. According to Shatan, about one hundred and thirty people attended the conference, "60 vets, 30 shrinks, 30 chaplains, and 10 central office people [VA] who came on at the last minute (Scott, 1993, p.45). At the conference, Lifton and Shatan spent time with reporters talking about the problems of Vietnam veterans.
The conference lasted for three days, April 26-28, 1973, and out of the conference the National Vietnam Veterans Resource project (N.V.R.P.) was created with a governing council of 16 people co-directed by Chaim Shatan and Jack Smith, with representatives from all three groups - veterans, chaplains, and mental health professionals. The project was to have several functions: to search and gather data on the effects of combat stress and to help coordinate a self-help movement of veterans groups (Shatan, 1987; 1997a).
There were direct consequences for this kind of advocacy. Beginning in 1970, Shatan came under government surveillance. Returning from a meeting at the Pentagon in June of 1973, he found his phone had been tapped. After a visit to Washington to offer assistance to American POW's returning from Hanoi, he discovered that someone had tampered with his mail.
In July of 1973, Shatan had been contacted by William Kunstler's Center for Constitutional Rights for help in preparing a "post-Vietnam syndrome" defense for the " Gainesville", eight veterans who had been charged with planning to blow up the 1972 Democratic and Republican conventions. After this, the interference with his mail was stepped up so that if mail came from veterans' organizations, people who worked with Vietnam vets, or Robert Lifton, it was bound to be searched (Scott, 1993).
The FBI tried to infiltrate the rap groups by sending in informers posing as veterans seeking help (Lifton, 1978). Through the Freedom of Information act, Shatan found that plans were even afoot to entrap him with blueprints of government munitions plants (Shatan, 1987). His response was to talk longer, louder, and more frequently in order to bring attention to the readjustment problems of the veterans and to make their cause more publicly visible and therefore less vulnerable to government sabotage.
The VA Central Office attacked Lifton and Shatan in the press when they made a guess that 20% of men who had served in Vietnam were paying a heavy psychological price, when the VA claimed that only 5% of the men had combat-related psychological symptoms. Both were labeled as being "hung up on the war" and accused of "dishonoring brave men" (Shatan, 1985).
Both Shatan and Lifton knew that it was impossible to separate the professional work they were doing with these men from their political activism. As Lifton recalls, "I believe that we always function within this dialectic between ethical involvement and intellectual rigor, and that bringing our advocacy "out front" and articulating it makes us more, rather than less scientific . . . From the beginning the therapeutic and political aspects of our work developed simultaneously" (Lifton, 1978, pp. 211 & 212).
It was difficult for Vietnam veterans to get the services they needed from the VA for several reasons, besides the existing, sometimes virulent, prejudice against the men who had fought in Vietnam and were suffering from the delayed effects of combat stress. First, there was no diagnostic code for combat stress in DSM-II. This latest edition of the Diagnostic and Statistic Manual for Mental Disorders, published by the American Psychiatric Association, had been published in 1968.
As Art Blank, points out, "As the return of troops from Viet Nam was reaching a crescendo, the psychiatric profession's official diagnostic guide backed away from stress disorder even further, and the condition vanished into the interstices of "adjustment reaction of adult life" (Blank, 1985, p.73).
But even under DSM-I there had been no classification for delayed stress reactions. So, if the symptoms presented more than a year after discharge from active duty, the VA did not consider them to be service-related problems. If veterans presented with post-traumatic psychiatric symptoms, they were misdiagnosed as suffering from depression, paranoid schizophrenia, character disorders, or behavior disorders (Blank, 1985; Wilson, 1988).
Senator Alan Cranston, a World War II veteran and a member of the Senate's Committee on Veterans Affairs, became convinced that the psychological needs of Vietnam veterans were different from those of older veterans. Starting in 1971 he tried to bring about changes in the VA system by seeking better funding for the Vietnam veterans to obtain drug and alcohol rehabilitation as well as the initiation of readjustment counseling services.
The bill he proposed passed the Senate in 1973 and 1975, but the House refused to pass it. The House was dominated by World War II veterans, who had an unwillingness to concede that the Vietnam War had produced different problems than had been previously recognized. In addition, the American Legion as well as the Veterans of Foreign Wars lobbied against the bill. Taking a more long-term approach, Cranston appointed Max Cleland as a member of his staff to review the VA hospitals.
Max Cleland was a Vietnam veteran who had lost an arm and both legs in the war and had testified for Cranston at the Senate Committee on Veterans Affairs in 1971. In his new position, Cleland visited Shad Meshad's storefront operations at Brentwood. Both Cleland and Meshad testified in 1975 before Senator Cranston's Subcommittee on Health and Hospitals, providing clear evidence that the VA hospitals were not meeting the needs of Vietnam veterans (Scott, 1993).
Besides the problems with the psychiatric diagnostic schemas, there was no organized Vietnam veterans' pressure group advocating for a change in benefits (Scott, 1993). The work of the National Vietnam Veterans Resource Project (N.V.R.P.), created during the First National Conference on the Emotional Needs of Vietnam-Era Veterans, began immediately after the conference. By 1974, the N.V.R.P. had catalogued 2,700 diverse veterans' self-help programs, 2,000 of them on college campuses, some out in the community and others in prisons (Lifton, 1973; Shatan, 1974).
Jack Smith sought funding for an empirical study and called it the Vietnam Generation Study, since the intention was to study both veterans and draft resisters. He and a colleague obtained funding from the National Council of Churches, the Russell Sage Foundation, and the Edward F. Hazen Foundation to begin a pilot study (Scott, 1993). In 1975, the Senate Committee for Veterans Affairs initiated a bill, approved by Congress, mandating the VA to conduct a study to assess the needs of Vietnam veterans. As a result, the VA provided funds to Arthur Egendorf and the NVRP to complete the Vietnam Generation Study, which eventually culminated in Legacies of Vietnam (Egendorf et al., 1979; 1981; Laufer, 1985).
The Mysterious Disappearance of Combat Stress
The first version of the Diagnostic and Statistical Manual formulated by the American Psychiatric Association was published in 1952, while American psychiatrists were actively treating veterans of World War II and Korea. "Gross stress reaction" was used to describe the aftereffects of previously normal persons who began having symptoms related to intolerable stress.
DSM-II was published in 1968, at the height of the TET offensive in Vietnam and "gross stress reaction" was replaced with "(transient) adjustment disorder of adult life". The only mention of combat -- as "fear associated with military combat and manifested by trembling, running, and hiding" -- was put in the same category as an "unwanted pregnancy" (Shatan, 1985).
As Chaim Shatan wrote many years later, The disappearance of stress reactions from DSM-II remains a mystery. Its causes have not been established. I have not been able to find a soul who will say they know how or why it happened . . . [but] we can say that the diagnostic lacuna in DSM-II had great political value during the Vietnam war . . . every diagnosis is a potential political act (1985, p.2-3).
For Figley, the absence in DSM-II of a diagnostic category specific to combat trauma can be attributed to the lack of American involvement in a war during that period, as WWII and Korean veterans became integrated into the community (Figley, 1978a). But Blank also believed that the elimination of "gross stress reaction" had been politically motivated, if not consciously, then unconsciously.
On looking back he concurs with Shatan, "These dramatic shifts from DSM-I to DSM-III suggest the
hypothesis that - as part of a highly complex social and intellectual phenomenon - irrational influences have deeply affected the recognition and appreciation of accurate guidance by organized psychiatry" (Blank, 1985, p. 74).
Wilson has puzzled over this mystery as well, pointing out that after the death of Freud the collective knowledge about psychological trauma seemed to go underground and by the time of DMS-II had all but evaporated. "What makes this so peculiar is that by 1968, the cumulative historical events involving war, civil violence, nuclear warfare, etc., produced more trauma, killing, mass destruction, and death in a limited time frame than at any prior time in recorded history" (Wilson, 1995, p.15).
Blank even now predicts that, for similar reasons, there will be a move to exclude PTSD as a diagnostic category when the DSM-V is formulated in the future (Blank, 1997a).
Whatever the reasons - and there probably were many - as early as 1969, John Talbott recommended that the future editors of DSM-III re-introduce the gross stress reaction listing. Talbott, later to become President of the American Psychiatric Association, had served in Vietnam as a psychiatrist. He conducted some of the initial interviews for the Vietnam Generation Study and was stunned by how much of this "post-Vietnam syndrome" he had been failing to diagnose in part because there was no way to make the diagnosis under DSM-II (Scott, 1990; 1993).
The Lost is Found: Post-traumatic Stress Disorder
CommunityWorks - Philadelphia, PA., USA
http://www.istss.org/what/history2.htm
Published in the International Handbook of Human Response to Trauma (2000), New York: Kluwer Academic/Plenum Publishers. Edited by Arieh Y. Shalev, Rachel Yehuda and Alexander C. McFarlane.
Shatan says that he first heard that traumatic war neurosis had disappeared in 1974 as a result of a phone call from an Asbury Park, New Jersey public defender. A Vietnam veteran had been charged with violence against property and had amnesia for his behavior.
The public defender entered a plea of not guilty based on traumatic war neurosis and the judge rejected the defense because there was no longer such a diagnosis. Shatan recommended that the public defender contact the DSM-III Task Force headed by Robert Spitzer. He did so and was told that there were no plans to reinsert any form of traumatic war neurosis in the DSM-III. A reporter from the Village Voice got this word back to Shatan and he was shocked. He got together with Lifton to decide what to do. They realized they had to mobilize, and mobilize quickly (Shatan, 1985).
Their response was to form the Vietnam Veterans Working Group (V.V.W.G.), supported, in part, by the American Orthopsychiatric Association and the Emergency Ministry of the United Presbyterian Church (Shatan, Haley & Smith, 1979).
The National Council of Churches did any xeroxing that needed to be done. Amitai Etzioni provided some office space for them at his Center for Policy Research at Columbia University (Shatan, 1997a; Scott, 1993). In 1974, Sarah Haley published her landmark paper, "When the patient reports atrocities" in the Archives of General Psychiatry, one of the publications of the American Psychiatric Association, and it was widely read.
John Talbott had easy access to the American Psychiatric Association. He sponsored meetings at the New York chapter of the APA, inviting Shatan, Haley, Arthur Egendorf and others to present on "Post-Vietnam syndrome". He also helped them get access to Robert Spitzer at the 1975 American Psychiatric Association convention.
Jack Smith developed a questionnaire as part of his doctoral thesis, "American War Neurosis, 1860-1970" and Shatan sent the questionnaire to 35 members of the VVWG in 1975, many of whom had been working closely with the veterans in rap groups and individual sessions, some as far back as 1970 (Shatan, Haley & Smith, 1979). He asked them to go through their caseload with the questionnaires.
Shatan and Lifton, joined by Jack Smith and Sarah Haley, tabulated the results on 724 veterans and arrived at a classification system very close to the one Kardiner had proposed in 1941 (Shatan, 1997b, Shatan, Haley & Smith, 1979; Van der Kolk, Herron & Hostetler, 1994).
While this was going on in the psychiatric establishment, Charles Figley organized panels in 1975 at the American Sociological Association and the 1976 meeting of the American Orthopsychiatric Association. He met with Chaim Shatan, Robert Lifton, and others, while beginning to work on an edited volume which, in 1978, would become a landmark book on Vietnam. Figley, a psychologist, had served in Vietnam in 1965 with the Marines and was one of the first Vietnam veterans to return home.
He completed graduate studies and participated in Dewey Canyon III. On campus, he met other Vietnam veterans and became aware of the widespread nature of their adjustment problems. After obtaining his degree, he took a position at Purdue University where he founded and directed the Consortium on Veteran Studies and started studying the post-Vietnam effects intensively. He developed a bibliography about combat trauma and began corresponding with other people interested in similar studies (Scott, 1993).
Meanwhile, John Wilson, a conscientious objector during the Vietnam War, began working on the Forgotten Warrior project. Wilson had completed his Ph.D. in 1973 and performed three years of alternative service in a crisis intervention center. When two close friends returned from Vietnam as radically changed people, a seed was planted in his mind. His first academic position was in Cleveland where a student of his presented a report on some Vietnam veterans he had interviewed on campus.
John was intrigued. He sent out letters to the veterans on campus and more than 100 responded. He and his student, Chris Doyle, recorded narratives of their lives before, during and after Vietnam and the work became consuming. His department chairman threatened to block his tenure or promotion if he continued this work, but John was undeterred. He set up rap groups at the university and requested funding from various organizations for a study.
But only in 1976 was he able, through the assistance of a disabled veteran, to get the Disabled American Veterans to provided the money he needed to complete the study (Scott, 1993). Out of over 450 interviews he and an associate, Chris Doyle wrote The Forgotten Warrior Project (Wilson, 1977).
In 1977, Figley chaired a research symposium at the American Psychological Association conference where he was able to arrange for the presentation of three papers: Egendorf and his colleagues' first version of what would ultimately become the Legacies of Vietnam study, (Egendorf et al., 1977), his own work from the Consortium (Figley & Southerly, 1977), and Wilson and Doyle's, Forgotten Warrior Project (Wilson & Doyle, 1977).
Each separate study supported and extended the other (Figley, 1978b) and provided even more support for the efforts of the V.V.W.G. in their attempt to change DSM-III.
Ironically, the decision to alter the DSM-III in relation to homosexuality may have had something to do with subsequent changes in the DSM allowing PTSD to enter the lexicon. The argument over whether or not homosexuality was a disease entity was so heated and politically loaded, that Spitzer decided it should be put to a vote. This indicated that the DSM-II could end up being completely redone, opening up negotiating room for those who wanted to reintroduce stress reactions into the classification schema.
In the summer of 1975, the V.V.W.G. invited Spitzer to lunch at Columbia Presbyterian in New York City. The group filled him on their activities and he was willing to appoint a formal committee, the Committee on Reactive Disorders, to proceed with the inquiry. He appointed himself, Dr. Lyman Wynne and Dr. Nancy Andreason to be the representatives on the committee with Andreason as chair.
She had previously worked with burn victims and knew about the long-term psychological as well as physical suffering that was involved in recovery from severe trauma. Spitzer instructed Andreason to work with Shatan, Lifton, and Smith. The appointment of Jack Smith, a non-M.D., was a highly unusual move. But the burden of proof still remained with the V.V.W.G. (Scott, 1993).
Convincing Andreason of the validity of the long-term reactions to overwhelming stress was key to the success of the venture. The Working Group reckoned that persuasion would be easier if they could show the similarities between combat stress and other forms of traumatic experience. So they recruited Harley Shands who had experience working with job-related trauma, Mardi Horowitz who was working on the physiology of stress, combined this with the research related to concentration camp victims that Niederland and Krystal had been doing, and contacted researchers working with other survivor groups to join in their mission.
Sarah Haley pointed out to Andreason that in reviewing the charts of the Vietnam veterans in the VA hospital, she had discovered that many of the clinicians were treating the patients as if there was a diagnosis of traumatic war neurosis available. This practical reality had a particularly strong impact on the discussions (Scott, 1993; Shatan, 1997a). Shatan, Haley and Smith presented their position paper at the 1977 annual meeting of the American Psychiatric Association, representing the accumulated work of the V.V.W.G. and making specific recommendations to the DSM-III Task Force for changes in the categorization system (Figley, 1978a; Shatan, Haley & Smith, 1977).
Early in 1978, Spitzer called the Working Group together to present their findings to the Committee of Reactive Disorders. Lifton, Smith and Shatan presented their evidence in a meeting with Spitzer, Andreason, and Wynne. They emphasized a wide circle of war zone victims, and the similarity between them and other victim groups. Later that month, the Committee released its decision, recommending a diagnosis of "post-traumatic stress disorder".
The DSM-III was completed and published two years later, having incorporated most of the recommendations made by the V.V.W.G., which were very similar to the observations made by Kardiner in the 1940's (Kardiner, 1941; Scott, 1993; Shatan, 1978b). Interestingly, at the same time as the V.V.W.G. were endeavoring to establish criteria for the DMS-III, another group of mental health professionals were working on a diagnostic system for dissociative disorders.
There was no communication between them and the PTSD working group, largely because very little academic conversation had yet occurred about the relationship between dissociation and trauma. As a result, a separate classification for the dissociative disorders was also entered into DSM-III and separate organizations subsequently developed to study these two related fields (Van der Kolk, Herron, & Hostetler, 1994).
In the meantime, President Carter had appointed Max Cleland as Director of the Veterans Administration and Alan Cranston assumed the chairmanship of the Senate Committee on Veterans Affairs. Cleland called a meeting with Art Blank, Charles Figley, Shad Meshad, John Wilson, William Mahedy and others to make specific recommendations for a VA readjustment counseling program.
Art Blank, a psychiatrist, had been drafted to serve in Vietnam in 1965. When he returned and got a position at Yale, one of his clinical positions was at the West Haven VA Hospital treating Vietnam vets. As a result of his own experience, he began diagnosing traumatic war neurosis in 1972, long before his colleagues were willing to see the effects of war on the returning veterans.
He made contact with Sarah Haley after reading her 1974 paper and through her, had met Figley and Shatan (Blank, 1998). Once the Vet Centers became a reality, he became the VA's Chief of Psychiatric Services. As a result of the changed political climate, at the same time as the APA was changing the DSM-III, Congress directed the Veterans Administration to create a nationwide system of specialized counseling centers (Vet Centers) for a wide range of readjustment problems in Vietnam veterans, including PTSD (Blank, 1985). The first Vet Center opened in 1979 and by 1990 there were almost two hundred around the country (Blank, 1993).
The Legacies of Vietnam study was published in 1981. In that year, Robert Laufer, the principle investigator of the study, testified before the Senate Committee on Veterans Affairs. Senator Alan Simpson wrote the Senate report summarizing the testimony and in it he said, "It does appear clear from the report that there is a continuing need for the Vet Center program and, as the findings of that study become more widely known, that need may become greater as veterans and their families come to realize that service during the Vietnam-era may have had an impact on an individual's ability later in life to adjust satisfactorily to his or her social environment" (United States Senate, 1981, p.16).
Convergence Creates a Social Movement Although the Vietnam War provided the "general tendency to change which is apparent in many spheres during wartime" (Jones, 1953), other converging and significant social forces played a role in bringing the recognition of the effects of trauma into the public consciousness in the United States and around the world.
The two most significant, and war-related events, of course, were the Nazi Holocaust and Hiroshima-Nagasaki. Robert Lifton had published an extensive study of Hiroshima victims (1967) a subject few people wanted to address, no more than they really wanted to confront the problems of Vietnam veterans or Holocaust survivors, all "politically incorrect survivors of atrocities" (Milgram, 1998).
William Niederland (1968) had already devoted twenty-five years to working with concentration camp survivors, noting that the same delay preceded their "survivor syndrome" as was being recognized in the work with Vietnam veterans. (Shatan, 1974).
Niederland, who Shatan had known for a long time, and Henry Krystal, who had also studied concentration camp survivors (Krystal, 1968), organized a conference on victimization at Yeshiva University in 1975 and joined the V.V.W.G. (Scott, 1993). Shatan, Lifton, and others working with the Vietnam veterans had already made international contacts as early as 1974 with other professionals working with veterans - in Canada, Switzerland, and Australia as well as Israel (Shatan, 1974).
In the early 70's, Shatan traveled to Israel and met with military psychiatrists there (Scott, 1993). In a letter to the director of the American Orthopsychiatric Association in 1978, Shatan reported that a liaison had been established with the National Institute for Research in the Behavioral Sciences of Israel (1978b). There, Dr. Rappaport and an American consultant, Dr. Israel Charny, were working on a project called the "Genocide Early Warning System", hoping to isolate and identify features in a society which prefigure the later development of genocide (1978b).
Studies also began to be published and conferences held in Israel on the effects of war stress there, a logical occurrence given the unremitting nature of warfare in the region (Benyakar & Noy, 1975; Milgram, 1978; Moses et al., 1975; Noy, 1978; Sohlberg, 1975; Steiner & Neumann, 1978). Noach Milgram organized the first of four international conferences on psychological stress and coping in time of war and peace in January, 1975 in Tel-Aviv, a year after the Yom Kippur War, and the second in June, 1978 in Jerusalem.
Both were attended by Israeli and U.S. participants (Milgram, 1998). Israel was naturally the home for a large number of Holocaust survivors, yet there was a "conspiracy of silence" in Israel about listening to their stories (Danieli, 1981), similar to the phenomenon Neff had described in reference to the Vietnam veterans with his observation that Vietnam veterans were invisible patients with an invisible (nonexistent) illness (1975).
Danieli and Solomon have both provided a framework for understanding the gradual transformation of Israeli society towards a willingness to comprehend the magnitude of post-traumatic problems (Danieli, 1981; Solomon, 1995a; b, c, d).
Yael Danieli had served in the Israeli Defense Forces before emigrating to the United States, where she founded the Group Project for Holocaust Survivors and their Children. During this period she had already begun her life work, exploring the intergenerational transmission of victimization, styles of adaptation to victimization, survivor guilt, and the attitudes and difficulties of mental health professionals working with survivors and children of survivors of the Nazi Holocaust (Ochberg, 1988b).
She would later go on to establish strong connections with the United Nations and become instrumental in bringing the concepts of traumatic stress to a wider international audience (Danieli, Rodley, & Weisaeth (1996). Ellen Frey-Wouters, a specialist in international law, and originally from the Netherlands, co-authored, with her husband, Robert Laufer, the third volume of the Legacies of Vietnam study while also writing about survivors of the Nazi Holocaust and working on social policy issues around the area of traumatic stress.
Many studies of concentration camp survivors were being conducted in Europe as well, including comprehensive long-term follow-up studies from Denmark, the Netherlands, and Norway (Bastiaans, 1974; Eitinger 1961, 1964; Thygesen et al, 1970). Meanwhile, also in Norway, Askevold studied the effects of prolonged stress on men who had served in the Merchant Marine in World War II (1976).
For the European community, Nazi occupations and the terrorism perpetrated by the Gestapo played a significant role in sensitizing them to the long-term consequences of excessive stress (Malt, Schnyder & Weisaeth, 1996).
Another effect of World War II was the vast movement of refugees. Eitinger began studies of refugees in Norway as well as studying concentration camp survivors (1960). The Vietnam War and the fall of Saigon in 1975 brought a flood of Vietnamese and Cambodian refugees to the United States. As early as 1979 reports began to be published about the adjustment problems they were having (Lin, Tozuma, & Masuda, 1979), opening up a discourse on how Westerners could most effectively intervene and help refugees from the East (Kinzie, 1978).
Independent of the DSM-III process and the effects of war, a number of other significant developments took place during the 1970s. One was Mardi Horowitz' Stress Response Syndromes (1976), which, building on Selye's earlier work (1956), began to provide a psychophysiological basis for understanding the body's responses to overwhelming experience and how that response connected to psychological processes.
Charles Figley (1978), edited the first significant collaborative book on Vietnam War veterans, and in doing so, introduced a new psychosocial series for Brunner/Mazel that by 1990 would grow to eighteen volumes of literature spanning every victimization category.
Crime rates in the United States rose rapidly in the 1960's and attention was also brought to bear on crime against women and children, probably for the first time in history.
The women's movement was instrumental in bringing attention to the incidence of rape and domestic violence that was being perpetrated against women. The first public speak-out on rape was organized by the New York Radical Feminists in 1971 and the first International Tribunal on Crimes Against Women was held in Brussels in 1976 (Herman, 1992).
In 1974, Ann Burgess and Linda Holstrom at Boston City Hospital described the "rape trauma syndrome" noting that the terrifying flashbacks and nightmares seen in these women resembled the traumatic neuroses of war. Susan Brownmiller and other feminist writers and thinkers redefined rape as an act of violence directed at maintaining dominance. In doing so, they placed the act of rape squarely in a political framework of power relationships, laying the groundwork for cross-fertilization with colleagues working with other survivor groups (Herman, 1992).
The feminist politicization of violence led to a deepening understanding of the abuse of power within the family, leading to the "discovery" of domestic battering and sexual abuse. As in the cases of delayed combat stress and rape trauma, domestic violence and sexual abuse awareness began at the grassroots, emerging out of feminist consciousness raising groups.
Lenore Walker published her landmark study on victims of domestic violence (1979), while Gelles and Straus released the results of major studies on family violence (Straus, 1977; Gelles and Straus, 1979). Around the same time, Judith Herman and her colleagues in Boston began to document the effects in adult women of having been sexually abused as children (1981). Rape crisis centers and battered women's shelters began to spring up in various communities around the country, outside of the traditional mental health systems.
Finkelhor has described the increasing professional concern about child abuse over the last several decades as being the "result of a broad social movement and a historic moral transformation" (1996, p.ix). C. Henry Kempe, pediatrician at the University of Colorado first described the "battered child syndrome" in 1962 (Kempe et al, 1962; Kempe, 1978). This conceptualization of child abuse brought the medical profession into this social movement with all the authority, prestige, and legitimacy necessary to bring about legislative change.
At first, clinicians and researchers like Green focused on the physical abuse of children (1978a, b). The 1970's saw the establishment of mandatory child abuse reporting laws and a widened system of child protection that was furthered and supported by the growing feminist movement (Finkelhor, 1996). But then Susan Sgroi (1975), David Finkelhor (1979), and others began to document the widespread incidence of the sexual abuse of children and the harm it was doing to them.
In 1973, the Children's Division of the American Humane Association testified before a Senate Committee, estimating that 100,00 children were sexually abused each year. Burgess and her colleagues noted in 1978 that "concern for the victims of sexual assault has become a national priority only during the past five years. In that time, both public awareness of and knowledge about sexual assault and its victims have grown immeasurably" (Burgess et al., 1978, p.ix).
As early as 1975, Shatan was studying the effects of other kinds of trauma on children. In 1972, he chaired a roundtable discussion at the IV International Psychoanalytic Forum in New York, comparing delayed survivor reactions in two parent groups: Vietnam veterans and concentration camp inmates, having noted significant symptoms of unresolved mourning in young adults who were children of World War II veterans from 1965-1970.
He presented a paper at the 1975 meeting of the American Orthopsychiatric Association (1975) looking at the delayed impact of war-making, persecution and disaster on children. But there was a great deal of professional resistance to recognizing that previously normal and healthy children could be severely damaged by exposure to psychologically traumatizing events. In 1979, Lenore Terr published the first of her series of papers and a book on the children of the Chowchilla, California kidnapping which introduced a developmental focus on the effects of trauma.
Elissa Benedek recalls hearing Terr present her data before a mocking and hostile professional audience who were determined to deny the effects of trauma and disaster on previously healthy children. As she puzzled over this seemingly irrational response on the part of a professional group she knew well, she concluded that 'this meeting was but another form or manifestation of a long tradition of denying psychological and psychiatric sequelae in the child victim of trauma.
The audience's response of disbelief in the face of carefully collected documentation, might have been so intense because it was difficult for professionals to accept that traumatic events, caused by fellow humans, in the lives of children might color and shape their lives for years to come" (Benedek, 1985, p.4).
Crime victimization surveys in the U.S. led to the development of the Law Enforcement Assistance Administration, a federal agency designated to provide victim service programs in the 1970's. While new services were starting, researchers were gathering data about the consequences of victimization to the individual and to the entire society.
In 1975, the National Organization of Victim Assistance (NOVA) was founded and other victim-centered groups emerged, such as Mothers Against Drunk Driving and Parents of Murdered Children (Young, 1988). Morton Bard became involved in the crime victim movement in the 1970's when he consulted with law enforcement agencies in New York City and later the National Institute of Justice (Bard & Sangrey, 1979; Bard & Shellow, 1976). He and Dawn Sangrey published a volume for crime victims in Figley's psychosocial series for Brunner/Mazel in 1979.
Both Robert Rich and Susan Salasin became involved in developing mental health programs and social policies to meet the needs of victims (Rich, 1981; Salasin, 1981).
On February 26, 1972, a dam burst in Buffalo Creek, West Virginia, destroying houses, a community, and many lives. K. Erickson wrote a book about the survivors of the Buffalo Creek disaster (1976) and other researchers, including Bonnie Green, and later, Jacob Lindy, followed up on the long-term effects of this disaster on the survivors (Gleser, Green & Winget, 1981; Lifton & Olson, 1976; Titchner & Kapp, 1976).
On March 28, 1979, a sizeable portion of the Unit 2 reactor at Three Mile Island experienced a meltdown, outside of Harrisburg, Pennsylvania, in the most serious U. S. commercial reactor accident to date. Some gaseous, but inert material was released, and no serious health consequences were expected. The population, however, had to be evacuated and a Task Force was rapidly set up to evaluate the highly publicized effects of this event on the affected populations (Dohrenwend, et al., 1981).
Other disaster studies began to emerge in the literature throughout this time period as well (Boman, 1979; Quarantelli & Dynes, 1977; Parker, 1977), building on a knowledge base that dated back to Lindemann's landmark paper on the Cocoanut Grove fire (Lindemann, 1944; Leopold & Dillon, 1963). Manuals on helping disaster victims began to be developed and published (Tierney & Baisden, 1979).
Beverly Raphael from Australia, began publishing her work around disasters and bereavement and she and John Wilson made early contacts with each other, thereby establishing a firm connection with Australia (Raphael, 1977; Raphael & Maddison, 1976; Wilson, 1997).
This growing body of literature on the psychological effects of disaster indicated that there could be long-term consequences of overwhelming stress in populations generally considered by the public to be free from any culpability in their experienced victimization. The high level of publicity given to disasters helped to increase the general level of consciousness about the consequences of trauma.
In 1974, a bank robber in Stockholm, Sweden took a bank teller hostage. They fell in love and had sex during a long siege in the bank vault (Ochberg, 1996). In the same year, the granddaughter of William Randolph Hearst and heiress to the Hearst fortune, Patty Hearst, age 19, was kidnapped by a terrorist group, while sitting at home with her boyfriend.
Until September of 1975, she was a captive of the group and was physically, sexually, and emotionally tortured. She developed a new persona and a new name, "Tanya" and was caught by the FBI while participating in a bank robbery with the group. In 1976 she was convicted and sentenced to seven years in jail, three of which she served (Hearst, 1981). This odd form of bonding between kidnapper and victim was later recognized in other types of captivity situations and came to be known as the "Stockholm Syndrome" (Strenz, 1982).
Frank Ochberg, a psychiatrist whose career decisions had been in part shaped by the assassinations of Martin Luther King and Robert Kennedy, co-authored a book on violence even as a psychiatric resident (Daniels, Gilula and Ochberg, 1970). He went to work for the National Institute of Mental Health and became the NIMH representative when the U.S. Department of Justice commissioned an inquiry into terrorism in 1975. As a result, he began to focus on victims of terrorism and hostage negotiations.
He served as Associate Director for Crisis Management at NIMH in the late 1970's, consulted to the U.S. Secret Service, and trained Air Force personnel about terrorism and sabotage (Ochberg, 1988a). He published an article on terrorism as early as 1978 in a new journal devoted to the study of terrorism and in 1982 he co-edited one of the first books on terrorism (Ochberg & Soskis, 1982).
In England, an article came out with the seemingly surprising finding that people not seriously harmed in a terrorist bombing were more incapacitated than would have been expected and they termed this an "aftermath neurosis" (Sims, White & Murphy, 1979) Across the nation and around the world, the growing global communication network was tuning us in to tragedy everyday. Trauma was in the air and a budding awareness began to emerge that the various forms of traumatic experience might be similar and even interconnected.
As early as a 1979 paper, Shatan, Haley, and Smith were already comparing the catastrophic stress of natural disasters, man-made disasters, combat trauma, incarceration, Buffalo Creek, Hiroshima, and internment in the death camps. The time was ripe for a convergence, for people to come together and share their knowledge, experience, and sorrow.
by Betty Friedan was published
