differences, more severe symptoms, higher depression scores, greater survivor guilt feelings, and more work disruption than World War II and Korean War veterans. In addition, despite similar rates of comorbidity overall, the Vietnam veterans were more likely to have panic disorder and PTSD. The differences in the veterans' reports of intensity of their experiences were interesting: WWII and Korean War veterans were most upset by general fear, fear of physical injury, and fear of incapacitation; Vietnam veterans, on the other hand, were traumatized most by witnessing brutality, sight of mutilated bodies, and loss of a friend in combat.
That stress reactions can set the stage for lifetime psychological difficulties is important in view of the nearly 50 years that have passed since the WWII testing programs with mustard agents and Lewisite. Indeed, a constellation of psychological problems may result from traumatic experiences, including depression, anxiety, panic disorders, and PTSD. Almost no data exist regarding the natural course of these adverse psychological effects over decades in the absence of treatment. A collection of case studies published by Macleod (1991) is pertinent to this issue.
Eighteen WWII veterans from New Zealand, identified as suffering from chronic PTSD, were interviewed extensively following routine psychiatric review for the War Pensions Claims Panel. Most of these men had not been treated for PTSD, but some had been treated for other psychiatric illnesses. The majority of the men recalled traumatic experiences during the war with great vividness and detail. Key among their emotional responses to these events was fear, physiological arousal, and helplessness. Two thirds of the men reported lifelong troubles with, or distance from, their spouses and families. Most interesting was the commonality of the reported long-term course of their emotional problems. This course generally began with a controlled response at the time of the trauma, followed by superficial attempts at coping with the incident. After the war ended, the men experienced significantly greater emotional difficulty for a period of time, but the schedule and routine of their working years was associated with a moderation of symptoms. A second escalation of symptoms arose in these men after retirement. The author concluded from this sequence that work became a distraction for the men and the cessation of working caused a reemergence of underlying problems. Although the conclusions drawn from this case study must be tentative, the paper supports the concept that PTSD symptoms, untreated and unrecognized over long periods of time, may nevertheless be traceable and diagnosable. Further, the suggestion is unavoidable that there may be many WWII veterans who have struggled unknowingly with PTSD or PTSD-like symptoms for decades.