Thank you for your service: Delayed recognition of US Vietnam War Veterans

[This article was originally written for a Military Psychology course I taught at Mount Saint Mary’s University in Los Angeles in 2016. It has been revised as a result of my tenure from 2019-2020 as the Training Specialist for the Department of Veteran Affairs’ Mental Illness Research, Education and Clinical Center in Portland, Oregon whose mission is to study and understand the biological and psychological underpinnings of military PTSD and Traumatic Brain Injury and, lately, to reflect new research.]

When the United States waded into Vietnam in the mid-1960s, it inherited a war already tangled in colonial history, civil strife, and the Cold War chess match. For U.S. leaders, the mission was simple on paper: stop the spread of communism. For the troops on the ground, it was anything but. The fight unfolded in dense jungles and rice paddies, against an enemy that often vanished into the very villages Americans were told to protect. By the time Saigon fell in 1975, more than 58,000 Americans had been killed, hundreds of thousands wounded, and millions of Vietnamese civilians displaced or dead. A generation of young Americans came home carrying memories no one had prepared them to process.

Those memories were not just of combat, but of moments that cut to the soul. Veterans later described the numbing shock of walking into ambushes, of losing close friends to sniper fire, or of witnessing the devastation of bombings that killed civilians along with enemy fighters. For many, the trauma was not only what they saw but what they were ordered to do. In one study, a Veteran recalled killing a child in the chaos of a firefight and said, “I knew it was wrong the moment I got the order” (Held et al., 2019). These stories reveal wounds that statistics alone can’t capture—wounds that bled into daily life long after the war was over.

Coming home should have been a relief. Instead, it often deepened the pain. Unlike the jubilant parades that welcomed back World War II soldiers, many Vietnam Veterans walked off planes into silence—or worse, open hostility. Protests against the war sometimes turned against the troops themselves. One Veteran put it plainly decades later: “They never really let us come home.” For young men and women already carrying guilt, shame, and grief, that rejection reinforced the sense that their service had been for nothing, leaving them alienated in their own country.

The psychological toll has been measured carefully over the years, and the results are sobering. The Department of Veteran Affairs’ (VA) Vietnam Era Health Retrospective Observational Study (VE-HEROeS) surveyed nearly 19,000 Veterans and found that those who served in Vietnam reported dramatically higher rates of PTSD, depression, and psychological distress compared with Veterans who never went to the theater or with civilians. Theater Veterans were nearly four times more likely to have PTSD and double the risk of depression, even decades after the war ended (Cypel et al., 2022). For many, the war simply never ended in their minds.

Suicide risk has also been a grim shadow. VA research using the Agent Orange Registry found that Veterans with PTSD had nearly four times the risk of dying by suicide compared with Veterans without PTSD (Bullman et al., 1994). Later work showed that both PTSD and depression carried suicide risks roughly seven times higher than those without the diagnoses (Zivin et al., 2007). These numbers are chilling, but they echo what Veterans have said themselves for years: that the hardest battles were often fought alone, long after the uniforms were hung up.

Part of the story is what clinicians now call moral injury. Unlike PTSD, which stems from fear and terror, moral injury comes from a different place: the shattering of one’s ethical compass. It happens when people do, witness, or fail to prevent actions that violate their deepest sense of right and wrong (Litz et al., 2009). For Vietnam Veterans, that could mean killing civilians, watching atrocities unfold, or simply surviving when their closest friends did not. Moral injury doesn’t always look like flashbacks or nightmares. Instead, it shows up as shame, guilt, anger, or a hollow sense that life has lost its meaning.

First-hand accounts collected by the VA and researchers give voice to these experiences. One Veteran described stumbling onto the aftermath of a helicopter crash and the mutilated bodies of friends he could not save. Another talked about the crushing guilt of living while his entire squad was killed. In a VA study, Veterans often said that existing PTSD therapies rarely touched the core of their suffering—that guilt and shame lingered, even after flashbacks eased (Currier et al., 2022). For many, silence about moral injury made it worse. “I could tell them about nightmares,” one Veteran said, “but not about the things I felt guilty for.”

Today, the VA is making strides to break that silence. New tools like the Moral Injury and Distress Scale (MIDS) help clinicians identify moral injury tied to specific events, giving therapists a clearer picture of what Veterans carry (Nash et al., 2013). Innovative therapies, such as Adaptive Disclosure, guide Veterans through structured conversations—with imagined moral authorities, fallen comrades, or even their younger selves—that help them work through guilt and begin to forgive (Litz et al., 2024). Others emphasize self-compassion, spiritual repair, or reconnecting with community. The goal is not to erase the past, but to help Veterans carry it in a way that doesn’t destroy them.

Half a century later, Vietnam Veterans are in their seventies and eighties. Many face physical ailments linked to Agent Orange exposure, chronic pain, or the realities of aging. Yet their mental health remains a central concern. The VA reports that, even now, Vietnam theater Veterans still have significantly higher rates of PTSD and depression than other groups (Cypel et al., 2022). Aging itself can stir up old wounds—retirement means more time to think, while the deaths of peers resurface survivor’s guilt. Still, there are signs of progress. Mental health services are better, society is more open about trauma, and Veterans are finally being invited to share their stories instead of hiding them.

The Vietnam experience reminds us that the costs of war do not end when the guns fall silent. For the general public, it is a lesson in empathy—an invitation to look beyond the stereotypes of the 1960s and see the individuals who served. For mental health professionals, it is a reminder to listen carefully, not just for trauma, but for the moral wounds that lie beneath. And for Veterans themselves, recognition, though delayed, is part of the healing. The memorial wall in Washington may be made of stone, but for many, it is the first place where the country finally said what they had waited decades to hear: thank you for your service.

References

Bullman, T. A., Kang, H. K., & Watanabe, K. K. (1994). Posttraumatic stress disorder and the risk of traumatic deaths among Vietnam Veterans. Journal of Nervous and Mental Disease, 182(11), 604–610. https://doi.org/10.1097/00005053-199411000-00002

Cypel, Y. S., Schneiderman, A. I., Culpepper, W. J., Akhtar, F. Z., Morley, S. W., Fried, D. A., Ishii, E. K., & Davey, V. J. (2022). The mental health of Vietnam theater Veterans—the lasting effects of the war: 2016–2017 Vietnam Era Health Retrospective Observational Study. Journal of Traumatic Stress, 35(4), 605–618. https://doi.org/10.1002/jts.22775

Currier, J. M., Farnsworth, J. K., Drescher, K. D., Nieuwsma, J. A., McCormick, W., Carroll, T. D., & Morgan, R. D. (2022). Addressing moral injury in clinical practice: A qualitative study of Veterans’ perspectives on treatment. Journal of Clinical Psychology, 78(9), 1766–1780. https://doi.org/10.1002/jclp.22887

Held, P., Klassen, B. J., Hall, J. M., Friese, T. R., Bertsch-Gout, M. M., Zalta, A. K., & Pollack, M. H. (2019). “I knew it was wrong the moment I got the order”: A narrative thematic analysis of moral injury in combat Veterans. Psychological Trauma: Theory, Research, Practice, and Policy, 11(4), 396–405. https://doi.org/10.1037/tra0000364

Litz, B. T., Yeterian, J., Berke, D., Lang, A. J., Gray, M. J., Nienow, T., … & Rusowicz-Orazem, L. (2024). A controlled trial of adaptive disclosure–enhanced to improve functioning and treat posttraumatic stress disorder. Journal of consulting and clinical psychology, 92(3), 150. https://doi.org/10.1037/ccp0000873

Marmar, C. R., Schlenger, W., Henn-Haase, C., Qian, M., Purchia, E., Li, M., … & Kulka, R. A. (2015). Course of posttraumatic stress disorder 40 years after the Vietnam War: Findings from the National Vietnam Veterans Longitudinal Study. JAMA Psychiatry, 72(9), 875–881. https://doi.org/10.1001/jamapsychiatry.2015.0803

Nash, W. P., Marino Carper, T. L., Mills, M. A., Au, T., Goldsmith, A., & Litz, B. T. (2013). Psychometric evaluation of the Moral Injury Events Scale. Military Medicine, 178(6), 646–652. https://doi.org/10.7205/MILMED-D-13-00017

Zivin, K., Kim, H. M., McCarthy, J. F., Valenstein, M., Austin, K., & Blow, F. C. (2007). Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs health system: Associations with patient and treatment-setting characteristics. American Journal of Public Health, 97(12), 2193–2198. https://doi.org/10.2105/AJPH.2007.115477