Gerald Nicosia's book Home to War: A History of the Vietnam Veterans' Movement, is fascinating reading, if only to keep in mind the wisdom of the George Santayana quote, "If we do not learn from the mistakes of history, we are doomed to repeat them." Nicosia goes into much detail about how the PTSD diagnosis was first determined and included into the DSM, and along the way he paints the picture of many of the key participants, including Sarah Haley, in first treating Vietnam veterans for combat trauma and the resultant PTSD.
Whenever we look at history like this, it becomes apparent that whoever is impressive today in this work owes so much to pioneers like Haley (who Nicosia discusses) and Lawrence Kolb, M.D. (who Nicosia oddly does not). "Standing on the shoulders of giants" is the semi-cliched expression about what present practitioners owe as a debt to the pioneers of the past, and it is certainly true about Haley's work: she was a true giant.
Here I'm going to excerpt, with Nicosia's permission, parts of the many passages about her work so you can see three important things: what her background was, which gave her a special compassion for the truth the veterans first presented with; the extent of her rapport with and trust established with the veterans themselves, which allowed her to help them; and some of her more intuitive leaps about what PTSD really meant from the lives of veterans with whom she consulted. What a truly remarkable person; and what a shame she's no longer with us, so that we can continue to benefit from her truly outstanding work with veterans. (Few of these quotes are continuous; most skip around from important part to important part, with the gap indicated by the ellipses)
Haley's background:
"It was a woman .. a psychiatric social worker named Sarah Haley, in the big VA outpatient clinic in Boston, whose research into veterans’ stress disorder literally blew the existing psychiatric definitions to pieces and began to put a whole new definition on the map.
"Sarah Haley [initially] seemed the least likely person in the world to make waves…
Her friends all warned her that the VA’s psychiatry program was “fifth-rate,” that she would find herself treating ‘chronic schizophrenia and passive-dependent men with bleeding ulcers,’ and that her career would surely go down the tubes. But despite the fact that she entered upon her new VA job with the meagerest of expectations, she couldn’t help being ‘shocked at the low caliber of the general run-of-the-mill health person there.’ As she recalls, ‘These were not mental health people that you would want anybody in your family to get near.’"
Haley's first astounding discoveries:
"One day, a young man in a highly agitated state was brought into the clinic by his parents. He had only been home from Vietnam for three days, and his parents had no idea what to do with him. He was having total body tremors and exhibiting ‘startle response’ every few minutes. If a car backfired or a door slammed, he would dive under the nearest table. After much rambling, the young man told her he had been at a place called My Lai, that terrible things had happened there, but that it was difficult to piece it together. He was confused and experiencing a lot of amnesia, but he did remember seeing the bodies of women and children and vomiting into the bushes. He also remembered that he could not shoot anybody himself, that he had thrown his gun down. The American soldiers who did the killing had sought to intimated him and the others who didn’t shoot: ‘If you ever tell anybody, we’ll come get you. Or we may come get you anyway.’
…
"Indeed, any other intake worker might have dismissed [this recent Vietnam veteran] as delusional, but Haley had reason to believe him.
(Her father had been on special operations with the OSS in North Africa during World War II, a self-admitted ‘assassin for the government.’ He had told her about seeing a truckload of German prisoners who were led out and made to kneel in front of a ditch, where an American officer shot each one of them methodically in the back of the head. Then the Americans dumped their bodies in the ditch and shoveled it over. Thus Haley, as she puts it, had “no illusions about war.”)
How Haley worked with veterans and understood their particular trauma:
"Haley had nothing to go on but a big hunch, but she decided to follow it. It seemed to hear that a lot of mental health professionals – especially those at the Boston VA clinic – had great difficulty in listening to the recital of trauma: as a defense, they either disbelieved it off the bat, turning it into the less threatening notion of “delusion,” or else withdrew from the patient as quickly as possible so as not to have to hear more about it.
The other horn of this troubling dilemma was that the traumatized person, especially if he was a Vietnam veteran, would almost never come in and spill his guts to a perfect stranger. Trauma patients need to establish trust with a therapist, and the Vietnam veterans coming into the VA clinic were never being given the chance to do this. It was by the merest lucky chance that the My Lai veteran had seen something in Sarah Haley that made him believe he could confide in her, thereby opening the door not only to his own dark secrets, but also to possible help for a whole generation of trauma victims.
Haley perceived correctly that the reason the My Lai vet could not remember all the details of his trauma was that much of the most painful material had been repressed. In the coming years, she would encounter the same phenomenon in hundreds of Vietnam veterans, some of whom could only recall five or six months of their 12- or 13-month tours of duty.
More insights into how Haley worked with veterans, and uniquely modified the approach for dealing with combat trauma:
"She further realized that the stuff was eating away at them would have to be brought slowly and steadily to the surface – that there were no quick fixes, like ‘5 mg. Stelazine daily.’ Equally ineffective, she would soon discover, was ‘the sort of non-authentic treatment’ where the professional would talk about family issues or other daily matters that were troubling the patient, but never bother asking about the existence of trauma in his past; for if the professional didn’t ask, the trauma victim would seldom bring it up on his own. Haley was aghast to learn, for example, that an analyst friend of hers had “successfully” treated a Vietnam veteran solely on the basis of working through the rivalry with his father and never even asked the veteran about his [combat experience.]
"Most of the Vietnam veterans Haley found were coming in to see a VA psychiatrist merely so that they could get their next month’s supply of Valium. Haley would go to the psychiatrists and inquire whether they had ever asked these veterans about their Vietnam experience; the usual reply from the shrinks was that they had stopped asking because the veterans didn’t want to talk about it. Haley was flabbergasted that none of the VA psychiatrists – with the exception of two notable women, Lillian Rodriguez and Constance Hartwell – evinced any interest in learning the cause of the tremendous anxiety for which they were blithely prescribing shelves of medication.
Unique problems to Vietnam veterans that Haley noted:
"During those first few years at the VA, Haley encountered a great many vets who talked about participation in atrocities. she found most of them to be ‘terribly guilty, feeling unclean, and not worthy to be back in the world.’
…
"… Instead of hearing, “Doc, I have a bellyache,’ or “Doc, I’m seeing visions,” or “Doc, I’m terribly depressed,” what Haley would hear time after time was, “Doc, I think I’m a murderer… I slaughtered innocent civilians.”
And finally, Haley's substantial impact:
"Working with these men and the material they brought up was so painful that it took Haley almost two years to complete her article…which was immediately recognized as a landmark work. By precise delineation of the symptoms of several veterans she had treated, Haley established that the Vietnam veteran who had witnessed or taken part in atrocities could not be handled merely as a traditional case of traumatic war neurosis, but presented a completely new challenge to psychotherapy."
Sarah Haley was indeed a remarkable woman, and a great Friend to Veterans. So much of the unique and compassionate approach to understanding PTSD's impact on veterans comes directly from this woman's work, and for that we are deeply appreciative and honor her in memoriam.
