The role of self-continuity in Vietnam combat veterans' recovery from trauma.

Abstract

The central hypothesis of this study was that recovery from traumatic events depends upon the development of a consistent life narrative which includes aspects of the trauma victim's pre-trauma life. Subjects were sixty Vietnam veterans who reported participating in heavy combat. Subjects varied with respect to level of current adjustment. Narrative data were collected for pre-war, Vietnam, and post-war experiences. Presence of current Post-Traumatic Stress Disorder symptoms was assessed using the Mississippi Scale for Combat Related PTSD (Keane et al., 1988). The MMPI-2 and the Social Adjustment Scale (Weissman & Bothwell, 1976) were also used to assess adjustment. The independent measure was Recovery Style assessed using a method developed by McGlashan (1987) from a reliably rated semi-structured interview. The Recovery Style most predictive of good current adjustment, including absence of PTSD symptoms, was Continuity--a sense that one's reactions to the stress of combat were consistent with pre-war dispositions, tendencies, and experiences. A multiple regression analysis showed that a high level of Continuity was present among individuals who reported getting into trouble more frequently before the war, being exposed to less severe combat in Vietnam, and being received more favorably when they returned from the war. Additional multiple regression analyses showed that the best overall predictor of current adjustment was self-reported assessment of reception following the war. Those who reported hostile receptions indicated more current difficulties. Monitoring, an individual's tendency to seek out information concerning threat (Miller, 1987), was also a strong predictor of poor current adjustment. Continuity was one of the best predictors of good current adjustment. Variables concerning subjects' prewar experiences, including family cohesion, educational difficulties, and perception of parents, generally were not predictive. The results supported the hypothesis that those veterans who were able to connect their responses to combat with ongoing life themes and conflicts avoided or recovered more fully from the potential trauma of severe combat. Though the results suggest many interpretations, one conclusion is that effective therapy should focus upon helping trauma victims achieve a sense of continuity between their pre-trauma personalities and their reactions to a traumatic event.