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"She made really interesting contributions that we think are valid and should be part of the conversation of PTSD today," says Juan Carlos Zaldîvar, one of Russell's co-directors. "I would imagine that it's a very tricky subject for the Army to talk about killing, because we, as a Western society, condemn killing, and we have to have people trained to do a job, to kill as a job. It's a bigger moral issue that we bring them [soldiers] back into a society that still thinks killing is wrong, even though they have done it for us."
Though MacNair's PITS concept is just one aspect of Soldiers Pay, her articulation of the hero-murderer complex is useful fodder for anti-war campaigners.
But MacNair developed the theory for use in a different political camp. Regardless of whether it's eventually accepted by the medical establishment, MacNair sees PITS as a political conversation starter that might someday help overturn Roe v. Wade.
When MacNair enrolled as a Ph.D. candidate in psychology and sociology at the University of Missouri-Kansas City in the late '90s, she sought to answer a seemingly simple question: How does the act of killing affect the killer?
"I was startled to find that we did not know how people responded to killing," she says. "There's a huge blind spot in the literature on this."
The "shell shock" afflicting some World War I veterans was thought to be physical, a lingering effect of blast waves. World War II veterans reporting "battle fatigue" were diagnosed with psychological problems, but some researchers classified nausea, shakes and involuntary bowel movements as normal reactions to combat. Limited studies done by the Centers for Disease Control, the American Legion and Columbia University found that Vietnam veterans suffered mental illness related to problems readjusting to civilian life.
For MacNair, Vietnam was the perfect petri dish: It involved close-quarters combat with soldiers who came face to face with those they killed.
At UMKC, MacNair solicited a copy of the National Vietnam Veterans Readjustment Study, the largest and most comprehensive statistical analysis of soldiers' reactions to war. Congressionally mandated in 1984, the study was performed by an independent survey firm and released by the Department of Veterans Affairs in 1990.
Tom Murtaugh, who coordinated the study, tells the Pitch that the data settled the question of whether vets' psychoses were real or peacenik propaganda.
After interviewing almost 1,700 American armed-forces veterans, researchers found that 50 percent of Vietnam vets suffered from mental problems. The rate of PTSD and other psychological problems was "often dramatically higher" among those directly exposed to combat. From the study came what is now the U.S. military's party line, that neurosis is a form of collateral damage. "[T]hose who were most heavily involved in war are those for whom readjustment was, and continues to be, most difficult," the report read.
MacNair decided to crunch her own numbers, breaking responses to the government's survey question ("Did you ever kill or do you think you killed someone in or around Vietnam?") into two categories: former soldiers who said they might have killed and those who said they hadn't.
Then, she looked at the percentage of PTSD-like symptoms each group reported. Her numbers showed that soldiers who said they had killed seemed much more likely to suffer psychological harm that those who said they had not, regardless of the battle intensity both groups had experienced.