New Publication on the Effects of the Vietnam War

Delaney Glass, a graduate student in biological anthropology at the University of Washington, kindly invited me to be part of a project on the effects of the Vietnam War (or Second Indochina War or the American war, depending on your perspective) on the health of older Vietnamese adults. The article is now in press in the Journal of Psychosomatic Research and titled: “Weathering within war: Somatic health complaints among Vietnamese older adults exposed to bombing and violence as adolescents in the American war.”

There’s a lot in here, but to me the main takeaway is that proximity to intense US bombing in adolescence, particularly early adolescence, was associated with health complaints decades later in older Vietnamese adults. I think it speaks to the long reach of war, and it adds to what we know about the many ways war can become embodied, lasting for a very long time in the health of survivors. It also provides another example of how the Second Indochina War disrupted health, as was the case in Laos and Cambodia.

Syria, After the War

Conscience cannot stand much violence. Once thoroughly broken down, who is he that can repair the damage?” – Frederick Douglass, “My Bondage and My Freedom” (1855, Chapter XI)

The war in Syria has to end, eventually. However, the tragic reality is that the damage is likely to last for decades.


Woman and child in Douma, Syria in Dec 2014. (AFP Photo/ Abd Doumany)

Yesterday, The New York Times reported that in the past few days “tens of thousands of civilians” have fled the city of Aleppo as the Syrian military, aided by Russian jets, have tried to reclaim the area. This is only the latest wave of civilians being forcibly displaced by the war. Altogether, the UN estimates that more than half of Syrians have been displaced from their homes at least once. Some of these have crossed into other countries, while the rest remain internally displaced.

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Some Lessons on War and Forced Displacement

Lessons from our SSHB conference on The Human Biology of Poverty, held in Lisbon earlier this month. Thanks to Ines Varela Silva for putting together a great conference in a beautiful country.

This is not a complete list, but a copy and paste of some of the highlights from our session: 


  • War and forced displacement: Embodiment of conflict-related experiences (Patrick Clarkin)
  • Female minor refugees: Are they underprivileged by forensic age estimation? (Bianca Gelbrich)
  • War and its effect on the changes in lifestyles: a case of Croatia (Sasa Missoni)
  • Secular trends of somatic development in Abkhazian children and adolescents for the last decades (Elena Godina)
  • Do stress biomarkers track poverty, stress, and trauma? Evaluating war-affected youth (Amelia Sancilio)
  • Refugees in Portugal: What do we know? (Cristina Santinho and Ines Varela-Silva)
  • Poster: Maya Guatemalan children in refugee camps in Mexico. How bad is their growth status? (Aya Ueno, Barry Bogin, Faith Warner and Ines Varela-Silva)

Summary of the session

Below are some reasons why our research is important and how it is relevant  for the public in general.

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Thoughts on PTS and “Moral Injuries”  


Over the past five years, a good percentage of this blog has been focused on the effects of war on health. Some of these topics have included:

  • Other effects of war, such as forced displacement, food shortages, and destroyed infrastructure (here, here, here, here, here, & here)


I’ve largely stayed away from one of the most recognized effects of war: psychological impacts such as post-traumatic stress (PTS), perhaps with one notable exception: “Reconciliation, Biology, and the Second Indochina War.” This remains one of my favorite posts on this site. However, it dealt not with PTS per se, but with guilt and the desire for forgiveness and reconciliation, with many examples stemming from war.

I bring this up now because a few months ago I first encountered the idea of the long-term effects of ‘moral injury.’ According to Litz et al. (2009), a moral injury stems from “events, such as perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations may be deleterious in the long-term, emotionally, psychologically, behaviorally, spiritually, and socially.”

In other words, while both have long-term psychological effects, moral injury may be distinct from PTS. As Thomas Gibbons-Neff wrote “unlike post-traumatic stress, which is a result of a fear-conditioned response, moral injury is a feeling of existential disorientation that manifests as intense guilt.” Neither idea is new, though both may have been unintentionally intertwined in psychology (at least in my non-expert understanding of this).

The terminology has been fickle, and PTS has been called many different names over the past several decades including shell shock, soldier’s heart, or combat fatigue. More recently, there have been efforts to drop the word ‘disorder’ from PTSD to simply PTS, in an effort to minimize stigma as well as to shift how those suffering from stress see themselves. Vocabulary really matters, and re-framing the terminology helps everyone see people with PTS simply as fellow human beings undergoing a very difficult period, rather than as permanently damaged.   

According to one study, references to post traumatic stress may extend as far back to the Assyrians in Mesopotamia between 1300BC and 609BC. Some ancient soldiers reportedly described “hearing and seeing ghosts talking to them, who would be the ghosts of people they’d killed in battle.” However, to me, this seems more like moral injury and manifestations of guilt, rather than fear, so perhaps these would be better categorized as moral injuries. Though it is almost impossible to do this retrospectively.

Some, like the primatologist Frans deWaal (2012), have suggested that the frequency of PTS among soldiers indicates that committing acts of violence does not come easily to humans, and that war is not a deep part of human nature:

“If there were truly a genetic basis to our participation in lethal combat, we should willingly engage in it. Yet soldiers report a deep revulsion to killing and shoot at the enemy only under pressure. After these experiences, they often end up with substantial psychological damage. Far from being a recent phenomenon, haunting memories of combat were already known to the ancient Greeks, such as Sophocles, who described Ajax’s “divine madness,” now known as posttraumatic stress disorder (PTSD).”

I’m not so sure. There is evidence that some people are drawn to violence and enjoy participating in it. A recent powerful essay by Tage Rai argued that the key to understanding human violence is that people are most apt to engage in it when they believe they are morally justified:

“Across practices, across cultures, and throughout historical periods, when people support and engage in violence, their primary motivations are moral. By ‘moral’, I mean that people are violent because they feel they must be; because they feel that their violence is obligatory. They know that they are harming fully human beings. Nonetheless, they believe they should. Violence does not stem from a psychopathic lack of morality. Quite the reverse: it comes from the exercise of perceived moral rights and obligations.”

If there is any good news, perhaps it’s that individuals who suffer a moral injury must, almost by definition, have some deep reservations about certain acts of violence. After all, one’s sense of morality cannot be injured if it didn’t exist in the first place. Secondly, the concept of ‘injury’ implies that healing is possible. Marek Kopacz (2014) wrote that after trauma, military personnel often seek out “support in an effort to realign their existential beliefs and reaffirm the meaning and purpose of life.” My guess is that — evolutionarily speaking — because humans have such a long history as social primates, it is likely that a person’s moral sense is integral to their meaning of life. Therefore, it is also likely that attempts at moral healing/ re-alignment could go a long way in terms of psychological health and overall well-being.



De Waal F. 2012. The antiquity of empathy. Science 336: 874-6. Link

Litz BT, Stein N, Delaney E, Lebowitz L, Nash WP, Silva C, & Maguen S. 2009. Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. Clinical Psychology Review 29: 695–706. Link

Kopacz MS. 2014. Moral injury – A war trauma affecting current and former military personnel.  International Journal of Social Psychiatry  60: 722-3. Link

The Biology of Forced Displacement

“Seeking asylum is not illegal under international law and people have a right to be treated humanely and with dignity.”  – UNHCR

We crossed the Mekong to get to Thailand at night, so no one would see us. We had always lived in the mountains (of northern Laos), so we did not know how to swim. When we came to the river, we used anything to help us float – bamboo, bicycle tubes. But at night, it is easy to get lost. Someone in our group said: ‘Remember, if you get lost when you’re going down the river (with the current), don’t panic. Thailand is on your right.’ ”



Every refugee has a story. The one above was told to me by a Hmong man I met in French Guiana in 2001. I went to learn about the experiences of the people there and how they had adjusted to being resettled half a world away, from Southeast Asia to a French ‘overseas department’ in Amazonia. They were actually doing quite well at the time, living as independent farmers who had been given land by the government years earlier.

Hmong men in French Guiana going hunting by bike.

Hmong men in French Guiana going hunting by bike.

They also retained a good degree of cultural continuity. While most are fluent in French, the majority of the 2,000+ Hmong in the country lived in rural, semi-isolated, ethnically homogenous villages. This gave them a buffer of sorts, allowing them to acculturate on their own terms. As they often put it, they were “free to be their own boss,” free to be Hmong, and most said they were happy with life in French Guiana. This combination of traits – economically self-sufficient, culturally distinct, mostly content, living in a rural overseas department – is not the typical refugee story. In fact, because of that relative uniqueness, the French Guiana Hmong have drawn attention from media outlets such as the BBC and the NY Times.

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Bombing of Laos, Animated

The organization Legacies of War shared this animated video on the impacts of U.S. bombing of Laos during the Vietnam War. I thought the filmmaker, Corey Sheldon, put together a very attractive and informative video, although the history is perhaps understandably simplified. Today, the remnants of unexploded bombs are still a problem in Laos, decades after the war has ended, so I think projects like this one are helpful in raising awareness, particularly in the United States.  <div style=”text-align:center”>


Related posts

The Lingering Effects of the War in Laos 

Laos: The Not So Secret War 


Mythic War

From Chris Hedges:

“Lawrence LeShan in The Psychology of War differentiates between “mythic reality” and “sensory reality” in wartime. In sensory reality we see events for what they are. Most of those who are thrust into combat soon find it impossible to maintain the mythic perception of war. They would not survive if they did. Wars that lose their mythic stature for the public, such as Korea or Vietnam, are doomed to failure, for war is exposed for what it is– organized murder.

But in mythic war we imbue events with meanings they do not have. We see defeats as signposts on the road to ultimate victory. We demonize the enemy so that our opponent is no longer human. We view ourselves, our people, as the embodiment of absolute goodness. Our enemies invert our view of the world to justify their own cruelty. In most mythic wars this is the case. Each side reduces the other to objects – eventually in the form of corpses.

for the lie in war is almost always the lie of omission. The blunders and senseless slaughter by our generals, the execution of prisoners and innocents, and the horror of wounds are rarely disclosed, at least during a mythic war, to the public. Only when the myth is punctured, as it eventually was in Vietnam, does the press begin to report in a sensory rather than a mythic manner. But even then it is it reacting to a public that has changed its perception of war.” 


― Chris Hedges (2002) War Is a Force That Gives Us Meaning (p. 21-22)


Forgiveness in Boston

Boston-Magazine Shoes

Cover of ‘Boston Magazine,’ by Mitch Feinberg

Less than a week after the Boston Marathon bombings, which left 3 people dead and over 280 injured, Cardinal Sean O’Malley emphasized the importance of forgiveness during Mass at the Cathedral of the Holy Cross. According to the Boston Globe, Cardinal O’Malley gave the congregation  two reasons to consider forgiveness. The first was  to avoid the “eye for an eye, tooth for a tooth mentality.” In that way, forgiveness offered a potential means to avoid further hostilities between groups. In fact, local tensions seemed to be simmeringO’Malley was likely cognizant of this, hoping to help defuse things before they progressed any further.  

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The Christmas Truce (Yet Again)

A couple of years ago around this time, I wrote a post titled Lessons from the Christmas Truce of 1914,” which is by far the most read thing on on this site.  Last year I had a lesser viewed follow-up about a man named Julio Diaz, a New Yorker who responded to a teenage mugger with compassion, which led to a conversation at a diner and the teen voluntarily handing over his weapon. 


Together, the two posts address some attributes we have as a species that facilitate cooperation,  even in times that are enormously challenging. These include, but are not limited to: empathy, the benefits of mutualism, and trust. We can find certainly find many counterexamples lately, with people inflicting great pain and suffering on each other. In recent memory, these include the horrific shooting deaths in Newtown, Connecticut  or the use of cluster bombs against civilians in Syria. This makes examples of cooperation all the more necessary.


To continue with this late December tradition, here is the story of a German fighter pilot from World War II named Franz Stigler and an American bomber pilot named Charles Brown:

On Dec. 20, 1943, a young American fighter pilot named Charlie Brown was on his first World War II mission. Flying in the German skies, Brown’s B-17 bomber was shot and badly damaged. As Brown and his men desperately tried to escape enemy territory back to England, a German fighter plane pulled up to their tail. It seemed certain death. Instead of shooting the plane down, however, the German pilot, Franz Stigler, escorted the Americans to safety.  (source)

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War as a Public Health Problem

The surgeon Gino Strada, who has worked in war zones around the world, once referred to war as “the biggest tragedy in public health.” It is debatable whether this empirical claim is true, but by re-framing the issue in this way we can see war with fresh eyes and as more than a conflict between political entities. Rarely, if ever, is war a matter that affects solely competing militaries. Recent images from Syria, Gaza, and Israel are the latest reminders of the impact of war on civilians. See these compelling photo essays here and here.

Aside from the obvious culprits of death, injury, and post-traumatic stress disorder, there are many ways that war can affect public health. As early as February of this year, food shortages were reported in Syria. One displaced woman told a reporter: “I can guarantee you this, people will starve to death.”

Food shortages in Syria. From CNN (Feb 21, 2012).

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