The Legacy of Combat Trauma

Abstract

Posttrauma symptoms can have a profound effect on the manner in which a trauma survivor relates to others, including, perhaps most significantly, family members. Survivors are markedly changed by their experiences. The psychological impact of trauma is well established in a variety of survivor populations (e.g., Burgess & Holmstrom, 1974; Davis & Friedman, 1985; Figley, 1978; Foa, Rothbaum, Riggs, & Murdock, 1992; Kilpatrick, Veronen, & Best, 1985; Koopman, Classen, &Spiegel, 1994; Laufer, Frey-Wouters, & Gallops, 1985; Titchner, Kapp, & Winget, 1976). These posttrauma symptoms include (1) experiencing the trauma through flashbacks, nightmares, and persistent thoughts; (2) cognitive and phobic avoidance of trauma-related stimuli; (3) hyperarousal symptoms of irritability, startle response, and sleep disturbance (American Psychiatric Association, 1994). It is easy to understand how survivors’ numbing of responsiveness, social withdrawal, and irritability, with episodic outbursts of rage, can make it difficult for them to maintain interpersonal relationships. In turn, children of traumatized patients may be affected directly or indirectly by their parents’ posttrauma symptoms. For example, Rosenheck and Nathan (1985) described a child of a combat veteran with post-traumatic stress disorder (PTSD) as having insomnia; headaches; tearfulness; feelings of helplessness; fears of being kidnapped, shot, or killed; attention problems at school; and fantasies similar to his father’s flashbacks. These authors coined the term secondary traumatization to describe this phenomenon. Others have referred to this as transgenerational transmission of trauma (Harkness, 1993). Although the terminologies differ, common to these descriptions is the notion that children are affected by their parents’ posttrauma sequelae. Despite a plethora of descriptive information, intergenerational transmission of trauma is a poorly defined empirical construct, and one that is not well understood within the professional community. We do not know the extent to which parental trauma affects the next generation or how many generations may be influenced. One of the best predictors for PTSD is the intensity and duration of exposure to traumatic events (Gleser, Green, & Winget, 1981; van der Kolk, 1988). We can speculate that one of the best predictors for secondary trauma in children may be the intensity and duration of trauma exposure of their parents. Combat veterans are a group that has been exposed to extensive trauma and, therefore, represent a population in which intergenerational transmission is likely. The objectives of this chapter are to describe the legacy of combat trauma on the children of Vietnam veterans and identify the mechanisms through which these cognitive, affective, and behavioral patterns are handed down. In addition, this chapter explores issues of how to determine if, when, and how to intervene.