The women who served in Vietnam

March is Women’s History Month. This article will discuss the effects the Vietnam War had on the women who served there. It will also suggest how California’s Veterans Treatment Courts might better serve our current women veterans.

I went back to Washington, D.C. in 2018 for the 25th anniversary of the dedication of the statue of three nurses which is part of the Vietnam Veterans Memorial in the National Mall. This past Veterans Day, I returned for the 30th anniversary. At both events, scores of women who served in Vietnam were there, almost all nurses.

Author Kristin Hannah was at the 30th. She gave each of us an advance copy of her book “The Women,” which was released in February. It’s about a young woman who served in the Army Nurse Corps in Vietnam, as I did. The book describes how the protagonist was unable to transition back into the civilian world in the days before the term Post-Traumatic Stress Disorder, PTSD, was even coined.

Hannah’s bestselling book is an apt entree into looking into what happened to the real women who served in Vietnam. Most of them were on the front lines in combat zones.

Diane Carlson Evans

Going back to 2020, I wrote an article on Veterans Day about Diane Carlson Evans. I note that in “The Women,” Hannah thanks Diane for her help in providing background for the book.

Diane came home from serving as a combat nurse in Vietnam and never shed a tear. Her default was “Tell nobody. Feel nothing. Risk Nothing.” Then she went to Washington, D.C. for the dedication of the Wall in 1982. As she read the names on the Wall, thinking “Who of you died on my watch? I’m sorry we couldn’t save you,” she heard “Ma’am, were you a nurse in Vietnam? The man gulped and looked nervous before saying in a quivering voice, “I’ve waited 14 years to say this to a nurse, but I never came across one. Until now. I can’t thank you nurses enough. I love you.” He then buried her in a smoldering hug. That’s when Diane began healing.

But Diane was concerned that when the various members of the military and other government officials, including President Ronald Reagan spoke at the dedication of the Wall and the Three Soldiers Statue of three men, none of them mentioned the 10,000 women who served in Vietnam, 80% to 85% of whom were nurses. She spent the next 11 years of her life forcing the military and the government to recognize those women. The result of her efforts is the statue of the three nurses tending a wounded soldier. It sits just a few bushes away from the Wall and the Three Soldiers Statue.

Like Hannah’s main character, Diane gave up nursing and spent much of her life in Montana. Today Diane is trying to beat a condition she has from exposure to Agent Orange.

Nurses in Vietnam

Army War College historian Iris J. West authored a brief history of the Army nurses who served in Vietnam. Three Army nurses arrived in Saigon in 1956 to train Vietnamese nurses. By December 1968, there were 900 nurses in Vietnam at any one time who worked in 24 hospitals.

Nurses usually worked six days per week, twelve hours per day. Throughout emergencies, everyone worked. Sleep was when one could get it. Although they practiced all specialties of nursing, the most common were surgical intensive care, recovery room, emergency room, and medical-surgical care. Nurses treated U.S. servicemen, Allied troops, American civilians, and Vietnamese men, women, and children side by side. In addition to their stated mission, Army nurses voluntarily gave medical assistance to the Vietnamese during their off-duty hours.

Disease admissions accounted for 69 percent of admissions between 1965 and 1969. Army Nurse Corps officers grew grimly familiar with malaria, viral hepatitis, diarrheal diseases, skin diseases, venereal diseases, and fevers of unknown origins.

Huey helicopters were the ambulances during the Vietnam War. They were spacious enough to transport medical personnel, equipment and the wounded soldiers. Those Hueys and their medevac teams dramatically reduced the delay between injury and treatment. Once at a medical facility, usually tents and Quonset huts, nurses and others would rush to the helicopter to triage the wounded. During the Vietnam War, those helicopter ambulances moved over 900,000 wounded troops.

Few seemed to notice or appreciate that women served in Vietnam

In 1982, while studying at the University of Maryland, Jenny Ann Schnaier wrote her thesis on “Women Vietnam Veterans and Their Mental Health Adjustment: A Study of Their Experiences and Post-Traumatic Stress.”

Schnaier said she selected the research topic because she read accounts about women Vietnam veterans and realized there was a lack of research about them. She describes numerous studies of Vietnam veterans that were conducted up until that time, adding “not one of the foregoing studies included women Vietnam veterans.” Perhaps not surprising, since she found the Veterans Administration [now called the Department of Veterans Affairs] didn’t even have a listing of the women who served in Vietnam. Nor did the Bureau of Labor Statistics, the Office of Personnel and Management, or the 1979 census list the women who served in Vietnam.

Absent scientific research or governmental lists of the women who served in Vietnam, Schnaier obtained the information Vietnam Veterans of America had. VVA’s mailing list was limited to those women who had voluntarily contacted VVA. Questionnaires were mailed to 97 women who served in Vietnam, and 89 responded, all nurses.

Not only had no one mentioned the women who served in Vietnam in the dedication of the Wall or the Three Soldiers Statue, but when Diane Carlson Evans telephoned the head of the Vietnam Veterans Memorial Foundation to talk about the possibility of a memorial for those women, he hung up on her. Her voicemail contained such messages as: “This message is for Diane Evans, the [fill in the blank] woman who thinks women deserve a statue. You’d better watch out.” A proponent of the Three Soldiers Statue said, “Who do you think you are? Forget about adding a statue of women. One statue is enough.” She was accused of climbing on the backs of dead soldiers to reach her moment in the sun. Hate mail, angry phone calls and threats were common. Secretary of the Navy Jim Webb wrote about a statue memorializing the women’s service: “There will never be an addition of another statue at the Vietnam Veterans Memorial. All these interest groups want statues, including the K-9 Corps.” One newspaper article said that adding a women’s memorial was like “painting the Statue of Liberty in Day-Glo pink.”

What Schnaier found

Schnaier found that more than a quarter of the women who served in Vietnam experienced stress symptoms between coming home and a year after leaving Vietnam, and 70% reported the symptoms were still present. Many felt the stigma of being a Vietnam veteran who people believed could go crazy at any given moment and they tried to be careful not to be portrayed in the same way. When asked if they had sought help for any mental health problems, almost half responded they had, but only 42.9%of those veterans ever discussed Vietnam in counseling.

The veterans reported their roles as women and nurses in the war was complex, ambiguous and guilt ridden. In the days prior to military service, they acted in ways they had been raised and trained--feminine, nurturing, passive and reactive. In the space of a few days, they were called upon to be medically assertive, active and in charge. That is, they experienced a complete role change overnight. Unlike men of the time, who had been taught a certain stoicism, the nurses had been taught to express emotions. Yet during the war, those women were forced to negate their emotions with an attitude of strength and survival.

When they got angry, the women didn’t have the option of release through the use of violence or weapons or drunkenness. The women felt isolated because there were so few of them. They had to make decisions about which patients received attention or equipment, often to the sounds of constant mortar attacks.

The nurses reported symptoms of depression, flashbacks, nightmares, guilt, anxiety attacks, suicidal tendencies, migraine headaches, spontaneous anger, alcohol or drug abuse, inability to sustain relationships, avoidance of intimacy, inability to hold jobs, sleeplessness, and uncontrollable persisting tears. Schnaier wrote that these symptoms suggested the existence of PTSD in the women veterans who had served in Vietnam.

Many of the nurses seemed to hold a specific incident vividly in their memories and used this individual tragedy to globally symbolize the horror and trauma of their entire war experience. Schnaier proposed that the Vietnam nurses’ exposure to such stressors as taking care of wounded soldiers, psychiatric casualties and patients who later died, seeing the mutilation of young bodies, and having a continual stream of casualties, supports the view that these women were at risk to suffer from PTSD.

Other studies

It took years before other studies were made of the effects of the Vietnam War on the nurses and other women who served there. But eventually, more studies were done.

An article in Military Medicine reported that the Vietnam Nurse Veteran Project identified specific stressors in the nurses’ environment in Vietnam, such as young age, severity of the casualties, danger to the nurses’ lives, sexual harassment, and survival guilt. Some of the after-effects included nightmares, flashbacks, career difficulties, and physical or emotional problems. The study revealed that nurses, like combat veterans, have suffered adverse after-effects from the Vietnam War, although the stressors of the war, for the nurses, were markedly different. Clinical Psychology’s articles reported similar results.

In another study of the mortality of female Vietnam-era veterans from 1965 to 2010, more than two-thirds of the women in the study were military nurses. Nurses who served in Vietnam had a two-fold higher risk of pancreatic cancer death and an almost five-fold higher risk of brain cancer death compared with military nurses who had served stateside.

A 2014 study by the World Health Organization evaluated women Vietnam veterans. Test results for part of the study revealed that 78.8% were positive for lifetime PTSD. A study found in the National Library of Medicine concluded there have been long-lasting mental health effects of Vietnam-era service among women veterans. Another study in the National Library of Medicine revealed that the nurses struggled with moral and ethical dilemmas of wartime nursing, and that the Vietnam War continues to affect the lives of the nurses who served there. They balance their personal and professional growth gleaned from this experience with the physical and emotional stresses experienced during the war and since the war.

Joan Furey’s research and personal struggle

Joan Furey was a combat nurse assigned to the 71st Evacuation Hospital in Pleiku during the Vietnam War. She came home to achieve her Master of Science in Nursing and spent her career helping veterans, particularly women veterans suffering from PTSD. Furey’s scholarly research and articles advanced our knowledge about PTSD. Her name appears on most of the research articles written about nurses who served in Vietnam. A 1991 comparison of studies was done by Furey. She concluded there is strong evidence that many women exposed to the stress of war have suffered mental health problems related to their experience, and a substantial number continued to have serious emotional, psychosocial, and other readjustment problems that affect their current level of functioning and life satisfaction. The consistent exposure to severe combat casualties, death and dying, workload extremes, personal deprivation, loss, and danger all took a significant emotional toll.

Furey wrote poetry to try to cope. Here is a portion of one of her poems:

VIGIL

Legs ache, head throbs Every muscle taut Every nerve on edge I want to scream but I can’t

Day after day, week after week

A parade. What about his family, his girlfriend—his wife and kids. He’s maimed, stumps where once there was a leg, and arm. A face even adults will hide from.

Their future? Mustn’t think of that. It could tear you to pieces giving them an identity of more than SOLDIER.

How experiences of women who served in Vietnam might help us in our Veterans Treatment Courts

Just as studies about women who served in Vietnam were few and far between, so are national studies about Veterans Treatment Courts. There was one done in 2018 that mentions that 94.8% of participants were male, but does not discuss gender differences. However, a multistate examination of women veterans in Veterans Treatment Courts was published this year in the Journal of Offender Rehabilitation. That multistate study predicts that the percentage of women veterans is on the rise. Women as a percentage of veterans are the fastest-growing cohort within the U.S. veteran population. Women who are jailed are also on the rise. Since 1980, the number of women in U.S. prisons has increased by more than 700%, outpacing men by more than 50%.

Just as we have seen with men, women come home from combat zones changed. A high percentage of women veterans who served in Vietnam suffered from mental health issues. Sometimes the stress was immediate, but often it was delayed. The stressors for women often differed from the stressors for men.

Most of the women in the recently published journal study had been deployed to combat zones and reported suffering physical or psychological injuries due to their military service. More than 90% had panic disorder, insomnia and PTSD, and 84% had suicide ideation after separation from the military. A high percentage of the women experienced sexual harassment and/or sexual trauma while serving. Given the statistically significant higher rates of gender-based trauma experienced by women veterans, the multistate study indicated that responsive programs such as Veterans Treatment Courts should have the ability to offer treatment services specific for women veterans.

The study concluded that women veterans are generally more likely to be living with psychiatric disorders and trauma. It lamented that treatment services especially targeting women participants are not commonplace despite other studies showing that women are more likely to complete treatment programs that account for their unique needs. It warns that Veterans Treatment Courts should prepare for potential increases in the number of women and be amenable to gender-responsive treatment for women veterans.

Conclusion

As many of the women who served in Vietnam are still suffering from mental and emotional traumas resulting from their wartime experience, there is little reason to think the following generations of women veterans who served in combat zones will fare any differently.

Participants in Veterans Treatment Courts have a much lower recidivism rate than others in the criminal justice system. Women veterans’ mental health traumas often result from different stressors than men veterans’ traumas. Granted, courts are always struggling with funding for programs. But due to the increase in the number of women in the military, it’s time to have gender-specific treatments available in our courts.

I will never forget one of the young women veterans I mentored in Orange County’s Veterans Treatment Court. She had been raped while serving her country. She was ordered into group therapy with the other veterans. She opted to drop out of the Veterans Treatment Court and go to jail instead. She explained to me, “I’d feel safer in jail than in a room full of military men.”