Wounds of war don’t heal in silence

Comments from nurses who have practised in war zones demonstrate the therapeutic importance of talking about PTSD.  

Nurses everywhere are becoming increasingly aware of the need for trauma-informed care as the impact of post-traumatic stress disorder amongst abuse victims, refugees and veterans grows. In this project, I set out to explore how nurses felt about and dealt with psychological trauma in war zones and how this has influenced nursing practices in relation to PTSD.

My research began with an exploration of the oral history collections at the Australian War Memorial*, looking for nurses’ firsthand recollections of psychological trauma. I have concentrated so far on nurses from World War II and Vietnam and this has revealed a number of common themes in relation to nursing practices, attitudes towards psychological trauma and the importance of talking.

Nurses in both WW II and Vietnam recall the use of specialist psychiatry or psychological units. In WW II, Ann remembers:

“We had what they call the bomb-happy ones, who had just reacted that they couldn’t cope with it for a time and so on, and they were put in the psychiatric ward.” (Ann S00776)

Ann did work in the psychiatric ward, under the direction of renowned Army psychiatrist Alan Stoller, and assisted with psychiatric treatments such as drug therapy and shock treatment.

Other WW II nurses recalled that talking to soldiers was an essential element of treatment and care:

“Well the main thing was to try and talk – counsel them.” (Una S00741)

“We would talk to them as much as we could and sort of bolster them up.” (Joan S00775)

Specific operational issues made nursing practice in relation to psychological injury in Vietnam different in many ways from that of WW II, although some essentials remained the same. Patricia indicates a familiarity with the multitude of issues soldiers experienced and the role of the unit psychiatrist:

“Personality disorders, alcoholism, transient situational disturbance … we had a psychiatrist up there with us, he really got down and treated the boys well … They used to try and bring those people home as soon as possible.” (Patricia K S01520)

Even in the triage atmosphere of the Field Ambulance hospitals in Vietnam, nurses did their best to relieve traumatic suffering:

“We never put them in a room and closed the door or pulled the curtain. We sat with them, we never left them.” (Colleen S01547)

All of the nurses studied so far stressed the continued role of talking as an essential component of treatment and support for returned soldiers, and noted the difficulties that Vietnam vets in particular experienced when they returned to a hostile social and political environment, in which they felt they couldn’t talk openly. This was in marked contrast to the WW II veterans, who were celebrated as victorious heroes and found ongoing support in regular commemoration. Patricia explained:

“Well, I think it’s just the same as the First World War. There was shell shock [then], and the Second World War it was called … battle fatigue and now it’s called PTSD … I don’t think it’s any different from the other wars except they were made to feel guilty.” (Patricia G S01522)

As Dianne articulates:

“I felt very angry at the Australian government … The wicked things they did to those boys, who were, you know, ordered to go up there, and then [the government] did not support them when they came home. That was … that was unforgiveable, really unforgiveable.” (Dianne S01521)

It was also difficult for nurses returning from war zones to talk about their own trauma. WW II nurses were hesitant to admit any impact:

“I can’t … I can’t recall what it did to me. I think it made me more aware of the suffering that the world goes through … it’s something I’m not really able to come to grips with now.” (Alice S00774)

This is in contrast to the Vietnam nurses, who all articulated deep psychological impact, including some symptoms of PTSD. This shift could be a result of broader social awareness, but it is also the case that the social and cultural factors of their return gave them an ever-present feeling that talking was off limits:

“All the ’70s I didn’t talk about it … It wasn’t acceptable to talk about it … ” (Patricia G S01522)

The effect that the wider social and political environment had on veterans and nurses is significant for contemporary practice. Public discourses about mental illness and PTSD in Australian society remain dismissive and stigmatising, despite significant public awareness campaigns. These recollections demonstrate that in this environment it is more important than ever that people experiencing PTSD, as well as the nurses who care for them, are encouraged and supported to keep talking.

* All excerpts from oral histories are reproduced with permission from the AWM. Records are identified in brackets using the AWM catalogue Series Number.

Dr Kylie Smith has a BA (Hons) and PhD in Australian health history and a background in Health Promotion. She is a Lecturer in Nursing history and Reflective Practice in the School of Nursing at the University of Wollongong.

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