Perspective
Americans as Survivors
N Engl J Med 2005; 352:2263-2265June 2, 2005
- Article
Physicians have always been concerned with how people survive trauma. There has been much interest in the psychology of the survivors of such massive trauma as that inflicted by the Nazis in their death camps, by the atomic bombing of Hiroshima and Nagasaki, and more recently, by the extraordinary earthquake and tsunami in South Asia.
Less noted has been the experience of Americans as survivors of violent collective trauma. We owe this lack of attention to the relative rarity of large-scale killing and dying on American soil and to the fact that in wars fought abroad, suffering has usually been countered by a sense of victorious achievement.
All this changed as a result of the Vietnam War, in which heavy American casualties were followed by defeat; then the terrorist attacks of September 11, 2001, which brought large-scale trauma home to Americans; and, now, the war in Iraq and the anguish and uncertainty associated with it. The collective psychological responses to these events reverberate throughout our society — as they would in any society undergoing similar trauma. These responses can be both painful and a potential source of illumination.
A survivor is one who has been exposed to the possibility of dying or has witnessed the death of others yet remained alive. The responses of survivors vary greatly, depending on the particular encounter with death and on personal traits. But I have found certain psychological patterns to be quite consistent.1 Survivors struggle with images of death and dying — what I call a “death imprint.” They feel a sense of debt to the dead, a need to placate them or carry out their wishes in order to justify their own survival. Survivors embark on an anguished quest for meaning and form, for what Erich Lindemann, in his classic study of the Cocoanut Grove nightclub fire in Boston in 1942, called “an acceptable formulation of [one's] future relationship to the deceased.”2 Human beings are meaning-hungry creatures, and survivors can epitomize this need by undertaking lifelong missions on behalf of the dead.
One can speak of both immediate survivors and more distant survivors, and there are important differences between them. Immediate survivors are those who have been directly exposed to death — as survivors of the attacks on the World Trade Center or of combat in Vietnam or Iraq or as family members of those who were killed. Their responses are visceral; their psyches have often been decimated, and they must struggle to reconstitute a sense of self. They bear wrenching psychological pain. Generally speaking, the nearer one was to the attack, the greater one's anxiety about death. After the attack on the World Trade Center, the levels of fear and of therapeutic need in New York City were found to be considerably higher than those elsewhere in the United States.
Distant survivors of September 11, 2001, or the Vietnam War include Americans in general. Their psychological wounds are less elemental, but their responses may entail considerable passion — a sense of individual and collective fear and vulnerability and feelings of injured national pride and humiliation.
Any experience of survival can connect psychologically with earlier traumas, with the losses and separations of ordinary life. Similarly, large-scale traumas can become intermingled. The war in Vietnam, the attacks on September 11, and the war in Iraq may blend within the individual American psyche, becoming virtually indistinguishable sources of pain and anger. This psychological blurring of the perceptions of events can contribute to collective confusion and a susceptibility to political manipulation.
No event, however destructive, has inherent meaning. Rather, the meaning must be constructed by those responding to the event — by both immediate and distant survivors and, later, by historians. Consider, for instance, two responses to the Holocaust. The slogan “Never again!” signaled the emergence, in the late 1960s, of the Jewish Defense League, a political movement that included family members of Holocaust survivors and did not hesitate to act violently against designated enemies. During the same period, in 1969, a group of Auschwitz survivors asked me to join them in protesting the massacre by U.S. soldiers of 500 Vietnamese civilians in the village of My Lai. That atrocity, which had just been reported in the American press, seemed, as one Auschwitz survivor put it, “too close” to his own experience. Antithetical as these two responses were, both expressed the searing emotion that such a powerful encounter with death can evoke.
Survivors may find healing in extracting wisdom from their experience and in combating the destructive forces to which they have been subjected. Hiroshima survivors have traveled the world to tell their stories and mobilize opposition to the nuclear arms race. Similarly, parents whose children have died of leukemia have joined or formed groups to support research aimed at preventing and treating the disease.
But collective survivor missions can also be bound up with mass violence and war. The Nazis drew skillfully on vengeful feelings in response to the humiliating defeat of Germany in World War I, summoning the image of the “stab in the back,” the betrayal, by Jews and others as the cause of that defeat. Promising national and individual revitalization, the Nazis derived mythic power from “the fallen” — Germans killed in the war — and at party meetings even called out their names to invoke their presence. There are probably few wars in history that were not fought on the basis of meanings given to the trauma of a previous war — that is, in relation to a mission to undo, reverse, or in some way alter the earlier outcome.
In response to the Vietnam War, the attacks of September 11, 2001, and the current war in Iraq, Americans' emotions as survivors have combined with ideological tendencies in polarizing ways. In the case of Vietnam, even during the war, opposition from U.S. veterans, active service personnel, and the public was widespread. With the American defeat, a broadly shared sense of meaning, experienced psychologically and politically, included the view that the United States should show greater military restraint and avoid wars with unclear goals in remote areas. An opposite meaning, built on similar emotions but a different worldview, held that any such restraint would be a sign of national weakness — the same kind of “weakness” manifested in that war by not making use of the potential of U.S. firepower. Hence, at the end of the first Gulf War in 1991, President George H.W. Bush triumphantly declared, “By God, we've kicked the Vietnam syndrome once and for all!”3
Leading advisers of the administration of President George W. Bush were also deeply affected by the defeat in Vietnam, which, as the writer James Mann observed, “led to a preoccupation with first regaining and then maintaining American military power.”4 Thus, in an important collective psychological sense, both the Gulf War and the war in Iraq can be understood as survivor missions in response to the Vietnam War.
In the immediate aftermath of September 11, Americans' shared responses of shock, fear, and anger blurred early differences in survivor meanings. These emotions were experienced by political leaders, who were able to channel them into an official survivor mission of a “war on terrorism” — a series of far-flung military and paramilitary actions, sometimes considered a crusade against evil, without clear limits in time or place. Support for that response, which included the invasion of Afghanistan and the overthrow of a government that had harbored the perpetrators of the attacks, was readily mobilized among Americans, struggling as they were with feelings of humiliation and victimization. Yet many moved beyond these feelings to contest the amorphous extension of the survivor mission to Iraq, which they thought had no discernible connection to the attacks on September 11.
An alternative survivor mission had a very different emphasis. Some Americans understood the attacks to be murderous acts of terrorism (even, in terms of the Nuremberg Principles, crimes against humanity) to which the response should be the use of only sufficient force to bring the perpetrators to justice. They raised questions about both the sources of the terrorism (including U.S. policies that might have contributed to Islamist extremism) and the failure of U.S. intelligence and other government agencies to prevent the attacks.
Much of the response embodied in this alternative mission was expressed by family members of those killed in the attacks, when they put pressure on the administration and Congress to conduct an official investigation that would probably not have occurred otherwise. Their mission resonated with large numbers of Americans, as part of a continuing struggle to grasp the meaning of the attacks.
The war in Iraq is being fought as a manifestation of survivor missions stemming from both the Vietnam War and the attacks in 2001. Yet once any war begins, it takes on meanings of its own. The dead become the ultimate moral focus, and the traditional survivors' mission is to ensure that they did not “die in vain” and to complete their work by prosecuting the war ever more vigorously. This survivor mission began with the first American death in the invasion of Iraq and extends to the continuing deaths of American soldiers and civilians at the hands of Iraqi insurgents.
The traditional response to war has been questioned by Americans who have given alternative meanings, psychological and ethical, to deaths in Iraq. They draw a parallel between the wars in Iraq and Vietnam: both are seen as unwinnable counterinsurgencies with unclear goals carried out in alien, hostile environments against enemies who are invisible and highly dangerous. A small but growing group of veterans of Iraq who embrace these alternative meanings have modeled themselves on the antiwar veterans of the Vietnam War.
Most Americans seem to be hovering between traditional and alternative responses to the war in Iraq. Though troubled by deaths in a war whose justifications are seen as contradictory, they are nevertheless loath to admit that Americans may have died in vain.
There have always been survivors critical of war, but frequently they are drowned out by traditional claims to glory. Even Homer's Iliad, in many ways a saga that immortalizes the heroic warrior, contains an undercurrent of sadness and suffering, with voices that question the purpose of war and the grotesque deaths and terrible sacrifices incurred. Such feelings reached an apogee in World War I, as expressed by the English soldier poet Wilfred Owen: “Starkly I return to stare upon the ash of all I burned”; “Foreheads of men have bled where no wounds were. / I am the enemy you killed, my friend. / I knew you in this dark.” A collective survivor mission has taken shape in the vast antiwar literature created by poets, novelists, and memoirists.
Vietnam veterans with whom I worked in the early 1970s could identify more with veterans of World War I than with those of World War II, who were often their own fathers and who saw themselves as having fought a necessary or “good” war. The alternative survivor mission of American veterans of the Vietnam War took the form of powerful public psychodrama when a number of these veterans threw their medals and decorations onto the steps of the Capitol in a passionate rejection of traditional claims to personal and national glory.5
Large-scale killing and dying always lead to struggles with collective trauma. As physicians and as citizens, we do well to examine the ways in which the psychology of the survivor enters into these struggles, since survivors, whether immediate or distant, seek relief and new knowledge from the pain of death and loss. Beyond their psychological effects on individual people, such events can have vast social and historical consequences. The way in which we survive them — the meanings we give them — will have a profound influence on the American future.
An interview with Dr. Lifton can be heard at www.nejm.org.
Source Information
Dr. Lifton is a member of the Department of Psychiatry at Harvard Medical School, Boston, and at the Cambridge Health Alliance, Cambridge, Mass.
- References
References
1
Lifton RJ. The future of immortality: and other essays for a nuclear age. New York: Basic Books, 1987:231-56.
2
Lindemann E . Symptomatology and management of acute grief. Am J Psychiatry 1944;101:141-148
Web of Science3
Bush GHW. Remarks to the American Legislative Exchange Council, March 1, 1991. In: Public papers of the Presidents of the United States, 1991. Book 1. January 1 to June 30, 1991. Washington D.C.: Government Printing Office, 1992:197.
4
Mann J. Rise of the Vulcans: the history of Bush's war cabinet. New York: Viking, 2004:52.
5
Lifton RJ. Home from the war: learning from Vietnam veterans. New York: Other Press, 2005.
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