title: "I Want to Come Home": Vietnam-Era Veterans' Presenting for Mental Health Care, Roughly 40 Years After Vietnam.
abstract: There continues to be an increase in the number of Vietnam-era veterans receiving a diagnosis of PTSD in the Veterans Health Administration, nearly four decades after Vietnam. In the present study, our aim was to better understand what prompts Vietnam-era veterans to present to a VHA mental health clinic, and to determine the meaning of this experience for them. Participants were interviewed regarding the experiences that prompted their visit to the mental health clinic at a VA medical center. Ensuing narratives were analyzed via phenomenological qualitative methods. Findings revealed that veterans did not hold a clear and determinate understanding of "PTSD" prior to attending the mental health clinic. Their engagement was instead the culmination of a long process wherein trusted others (e.g., family, other veterans, primary care doctors) suggested that their difficulties may be indicative of a problematic pattern that required attention beyond the everyday ways of dealing with them. In general, veterans suffered from a longstanding experience of social rejection, abandonment, and even betrayal following the war, including pervasive stigmatizations and perceived "weaknesses," and their own preferences for self-reliance over inattentive social and governmental institutions. Many veterans were newly focused on renewing meaning and purpose in their lives. The findings suggest the need to build stronger bridges between the VA and veterans' community supports, who greatly influenced veterans' care seeking. Further efforts to welcome Vietnam-era veterans home, validate their experiences of rejection and abandonment, and respectfully process their ensuing pain and anger are warranted.
authors.affiliation: Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA. miraj.desai@yale.edu.
authors.forename: Miraj U
authors.initials: MU
authors.lastname: Desai
authors.affiliation: Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Pavlo
authors.affiliation: Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Davidson
authors.affiliation: Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA.|VA New England, MIRECC, 950 Campbell Ave., 151D-MIRECC, West Haven, CT, 06516, USA.|National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, 950 Campbell Avenue, 151E, West Haven, CT, 06516, USA.
authors.forename: Ilan
authors.initials: I
authors.lastname: Harpaz-Rotem
authors.affiliation: Department of Psychiatry, Yale School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA.|VA New England, MIRECC, 950 Campbell Ave., 151D-MIRECC, West Haven, CT, 06516, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Rosenheck
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D013997:Time Factors; D014728:Veterans / Q000523:psychology*; D047829:Vietnam Conflict
keywords: Mental health; Phenomenology; Qualitative research; Veterans; Vietnam war