The Vietnam War was the big bang that hurled us into awareness of trauma and sparked the birth of what was to become the field of traumatic stress studies. I say both “the” and “Vietnam”, somewhat embarrassed by a new awareness of another expression of cultural chauvinism. Centuries of war bloodied that small country, colonized and embattled with China, Japan, France, Britain, Cambodia… so “the” war with the US was one of many. Similarly, I am newly aware that spelling “Vietnam” as one word instead of two is somewhat of a corruption of the indigenous “Viet Nam”, which ironically means “unity.” 

American veterans returning from that war with glaring, seemingly intractable symptoms, commanded long-needed attention to what in 1980 became the diagnostic category of overwhelming experience: PTSD. Nightmares, flashbacks, irregularities of memory, exaggerated startle response, depression, and anxiety all became the growing and perhaps similarly overwhelming list of boxes to check. When I worked at the VA some 15 years after the real-time end of the war, I saw how many of the aging men, (and most of our patients were men,) were still living it. Florid drug addiction blanketed many of their unbearable symptoms. Sadly, living close to Haight Ashbury and Golden Gate Park, I believe some of our homeless are those same guys, now 48 years older.

I recently woke to another population that at least I had completely ignored. Once again, I was awakened by an interview in the wee hours on public radio with Viet Namese author Que Mai Phan Nguyen about her new novel Dust Child. Besides the population of US veterans I am familiar with, and (by now I have had more than a few clients who were their sons and daughters,) I became aware of vast groups, generations, of attachment-traumatized American veterans, Viet Namese women, and Amerasian or mixed-race offspring of the two. 

The novel artfully weaves together threads of three different stories representing a new view of the intergenerational transmission of attachment trauma and neglect. We meet a white male war veteran, like most GIs, barely more than a child when he finds himself embroiled in a bloody war far from home. Like most of his cohort, he does not choose to be there and does not really understand what it is all about. Like many of his buddies, lonely, bored, and desperately needing to block out painful reality, he whiles away his evenings in the seedy bars of Sai Gon (also two words in the native language,) drinking and being “entertained” by attractive young local women.

Secondly are the sad stories of painfully young Viet Namese women attempting to stave off starvation and save their families from homelessness by working in bars, serving drinks and providing company, and “more.” And finally, a generation of “Amerasians,” the often abandoned and orphaned offspring of desperate and lonely bar liaisons. These children are of any and all mixed-race colors, with apparently African American fathers (these being the most painfully outcast,) some mixed Asian and Latinx, and every imaginable variation. Our character in the story is dark-skinned, curly-haired, and unspeakably lonely, longing for family, hopelessly wishing his father would come looking for him and transport him to the dreamed-of better life in the US, and in search of a loving mother who would want him.

One protagonist is the now middle-aged white veteran, visiting Viet Nam and searching for the beautiful barmaid whom he had truly loved, now ashamed that he had both cheated on his faithful wife waiting at home and had left his young girlfriend pregnant. He did not know if the girlfriend or the child of unknown gender had survived the war.

We get the backstory of the then-young “girlfriend,” fleeing the extreme poverty of the countryside, seeking to earn enough to keep her family from losing the small plot of land that sustained and housed them, only to discover she had unwittingly signed on for sex work. I won’t spoil the rest of the story. Suffice it to say, the battlefields of Viet Nam are haunted by the gruesomely dead, the walking wounded, and the multitudes of ghost-like orphaned and abandoned whose invisible scars of attachment trauma, deprivation, and neglect leave many with huge questions about identity.

Unsung Heroes

I have always been amazed that Madonna and Jane Fonda looked so good, close to my age or older. Until I realized, well, parts of them are close to my age or older. They, and others like them, had had a lot of “work” done. Of course. I never knew the history of the science and art of plastic surgery until I recently read The Facemaker, a biography of the surgeon Harold Gillies. Gillies, born in New Zealand, was just completing his medical training when World War 1 broke out. Again, I was quite ignorant about this chunk of world history, and how that war was of a magnitude and scope of agony that seemed new even to the larger world. It also brought a new generation of weaponry that wrought new iterations of destruction: tanks, chemical warfare, bombs, rapid-fire guns. 

Besides the sheer numbers of dead and seriously injured, what compelled young Gillies was a massive increase in the appearance of young men whose faces had been blown apart. The damage was often so extreme that existing medical procedures and technology were completely unequipped to address it, let alone keep up with it. And where veterans who lost limbs and returned home in wheelchairs were often viewed as heroes, those with destroyed and disfigured faces looked so grotesque and frightening as to be repulsive to people, even their own children, fiancées and spouses. Even some medical personnel found them unbearable to look at while facing the new challenge, without protocols or textbooks, to develop techniques to try and put them even minimally back together. And, of course, the challenge was not only to “form” but also “function.” Not only was there a mandate to enable them to look such as to continue some semblance of “normal” daily life, but their faces, and the structures below, needed to be able to breathe, eat, and speak. 

Gillies made that his life’s work and became one of the founders of the art and science of plastic surgery in the process. In the beginning, plastic simply meant capable of being molded or receiving form, rather than a universe of ocean-strangling junk that we use to make virtually everything. Gillies and his comrades were truly creating an art form. In fact, alongside his unimaginable medical schedule, he added art classes so he could begin to draw and thus teach some of the techniques and procedures he was inventing. A massively energetic and generous human being who transformed many lives.

It was startling to me, as it often is when I discover a whole new category of knowledge or history that confronts me with a whole world of trauma and pain I had perhaps not thought about before. And unsung heroes that most of us never hear about. My own “petty” complaints about the appearance changes that come with natural aging; and narcissistic even identity related losses, paled into shame as I read these tragic accounts of young people in their twenties, trying to serve, or at the very least do what they were told, and being met with catastrophic losses of their sense of self. Often, they were greeted by a revolted and rejecting world, even their families. The horror was simply too much. This extreme of trauma shattered the interface of mind, brain, body, psyche, relationship, and most decidedly, sense of self. 

Humility

For many a survivor of trauma and/or neglect, sleep is a minefield. It may be the desperate quest to get to sleep, or the problem may be staying asleep long enough to get rest. It may be the movie-like screening of haunting nightmares. It may be a memory relived, with or without awareness, of traumas that invaded or upended the childhood bed. It may be the fear of the insomnia itself. Young parents, medical professionals with 24, 48, even 72-hour shifts, emergency responders… how do they do it?

It took me a long time to remember some of my worst experiences in bed. But I always did remember waking up alone in the dark cold of my hospital room when I had my tonsils out at age 3. In those days, I guess mothers (or a parent) did not stay by the bedside of a tiny child. Waking up alone and terrified, with a painful raw throat, no one around, and it was so dark. Where was everyone? Anyone? And they had promised there would be ice cream. Where was the ice cream? 

I remember another time, waking up alone from an afternoon nap in the little bungalow where we summered in Fleischmanns while my father waited tables in the luxury resort. I was again, about 3. And again, terrified. Where was everyone? And I remember always being so scared of the dark that when I went to the bathroom in the night, I ran like hell back to the bed, not knowing who or what might be chasing me. 

The mythical “good night’s sleep” can become a torturous quest, certainly, for the hyper-aroused nervous system of survivors of whatever the trauma. And although our world is now glutted with remedies, pharmaceutical, over-the-counter, legal and illegal, “alternative,” not to mention the wide world of apps, devices, and mindfulness practices. Many have tried them all. Many continuing in exhausted despair.

For me, the first step, as is all too often the case, was having the humility to face that this is a problem; and a problem that could be dangerous to my health. What might be the impact of at least a decade of four-hour nights? Maybe I am simply a human organism after all, an ordinary mammal, not superhuman or subhuman, bionic or undeserving.