Combat Trauma: Imaginaries of War and Citizenship in post-9/11 America
Nadia Abu El-Haj
Verso, $29.95 (paper)

Nuclear Minds: Cold War Psychological Science and the Bombings of Hiroshima and Nagasaki
Ran Zwigenberg
University of Chicago Press, $35.00 (paper)

“For me all that took place in Vietnam was inseparable from Hiroshima,” wrote the American psychiatrist Robert Jay Lifton in his 2011 memoir, Witness to an Extreme Century. He was referring to the 1945 U.S. detonation of an atomic bomb over the Japanese city, which killed over 140,000 people, and the 1968 U.S. military killing of up to 504 unarmed civilians in South Vietnam in what later became known as the My Lai massacre. For Lifton, the two events, separated by over twenty-three years and nearly two thousand miles of ocean, were key for his research: he published influential studies of the psychological impact of war based on interviews with Japanese survivors of the former catastrophe and American perpetrators of the latter. These two catastrophic events are also both connected, via Lifton, to the history of post-traumatic stress disorder (PTSD) as a diagnostic category.

Visiting Hiroshima in 1962, Lifton was struck that no study had yet “recorded systematically what went on in the minds of survivors, individually and collectively,” and determined to undertake such a project himself. He interviewed survivors, known as hibakusha, and grappled with the uneasy feeling of meeting with people whose suffering had been caused by a weapon with which he “had a shared nationality.” After his initial interview with a man who had witnessed the bombing, he felt so shocked by the testimony that he immediately wished to deny everything he had heard—a reaction he later observed was analogous to broader societal attitudes to nuclear weapons.

Lifton’s interviewees, recalling the day of the bombing, told him of the black rain they had seen pouring from the sky, of the city’s white castle in ruins, of the cries of their neighbors, of children vomiting dark liquid, of the reddish spots caused by radiation that appeared on the skin of their loved ones, of blue phosphorescent flames rising from cremated corpses. Many remarked that what they had seen resisted description altogether. Reflecting on their experience in the present, they spoke of their incessant nosebleeds, of pervasive fears for the health of their offspring, of constant anxiety about potentially dying of leukemia, of their struggles with work and housing, of the difficulties they had sleeping, of the large and disfiguring keloid scars on their bodies. A divorced housewife remained haunted by the clouds that had stretched out like a giant hand expanding to crush everyone in the city. Another survivor who had been exposed to the blast told Lifton of his recurring dream:

I am walking along in a place that is like a desert. There is absolutely no shelter anywhere. Then I see a plane flying above, which I know is carrying a nuclear weapon. I am terrified, because I realize that when the bomb falls, I will have no protection. At that moment I wake up.

Lifton described a process of what he called “psychic numbing” experienced by survivors who reported becoming emotionally closed off in response to the horrifying scenes of mass death they had witnessed. Through their encounter with death in an event that many likened to the end of the world, Lifton argued, Hiroshima survivors experienced “symbolic immortality” by continuing to live and feeling themselves part of something that would outlast them into the future. Many of his subjects spoke of their wonder at the natural beauty that continued to flourish in Hiroshima in the wake of the atomic blast. Some interpreted these signs of fresh growth as a glimpse of hope for the future; others, though, associated them with their feelings of guilt for having survived. A hibakusha poet described looking at the grass and trees that had grown from the bone-strewn soil in Hiroshima and imagining them as “the eyes of the dead, looking at the people who had survived.”

His Hiroshima work became the starting point for theories that centered the experiences of survivors of catastrophic historical events, which he developed across decades—and, since he was driven to undertake his research partly due to his opposition to nuclear weapons, were informed by his political commitments. But around the time Death in Life: The Survivors of Hiroshima was published in 1967, he did not join the hundreds of U.S. intellectuals who signed the antiwar proclamation “A Call To Resist Illegitimate Authority” as he was fearful of the potential repercussions. After reading revelations about the My Lai massacre in the press in 1969 he felt ashamed by his inaction and decided to embark on a research project about its perpetrators hoping to, in his words, “compensate for that earlier failure.” Having heard rumors of a U.S. soldier who had refused to fire on civilians at My Lai, Lifton tracked him down and interviewed him for eight hours about his memories of that day. Over the next few years Lifton became involved with Vietnam Veterans Against the War (VVAW), a group with whom he participated in weekly “rap groups” during which former soldiers spoke not only of the losses they suffered and violence they perpetrated in Vietnam but also of their struggles and feelings of alienation back at home. Events like My Lai, he had come to believe, should be understood as “atrocity-producing situations” that drove ordinary people to participate in extraordinarily brutal violence. Understanding and treating those people, many of whom came home haunted by guilt and staunchly opposed to the war, was something with which Lifton believed psychiatrists could help.

The work with hibakusha and Vietnam veterans helped feed into the emergence of a new diagnostic category: PTSD. Lifton participated in the working group whose reports contributed to the 1980 approval of the new classification, which entered the third edition of the Diagnostical and Statistical Manual of Mental Disorders (DSM-III) that year. But according to its critics, PTSD has failed to preserve the political intentions that drove Lifton’s work. In his 1995 study, The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder, Allan Young argued that the centrality of Vietnam veterans to the concept’s origins has had moral and political implications. PTSD, he wrote, does not differentiate between “victims of unusual violence and perpetrators of unusual violence,” an argument echoed more recently by scholars including Joseph Darda and Dagmar Herzog. It’s not difficult to find evidence to support these claims. After all, both protesters and cops were diagnosed with PTSD in the aftermath of the Ferguson uprisings in 2014, and again during the 2020 George Floyd uprisings. In many ways, PTSD seems amenable to a kind of both-sidesism: extreme events can be traumatic for everyone involved, and the remedy for that trauma need not consider thornier matters of structural injustice. Traumatic wounds can be tended without challenging their social causes. Seeing the diagnosis from this vantage raises the question: What happened to PTSD? Is it that the very category, by casting the soldier or cop as a passive victim, is inimical to social change? Given Lifton’s own anti-imperialist beliefs and activism in the peace movement, why does PTSD now seem so resolutely apolitical?

In Combat Trauma, Nadia Abu El-Haj works through the question of Lifton’s role in the discussions that led to the DSM’s adoption of PTSD before tracing the political implications of its subsequent redefinitions into the post–9/11 era. Situating a constellation of debates about victimhood in the broader rightward political climate of the Reagan era, she argues that the shift from “agent” to “victim” occurred between the publication of the DSM-III in 1980 and the revised DSM-IIIR in 1987. The bulk of her analysis focuses on PTSD in the context of the U.S. military’s wars in Afghanistan and Iraq, drawing on ethnographic research with clinicians who have treated veterans of those conflicts. By 9/11 PTSD was recognized as a widespread reaction to prolonged combat. As a result, federal funding for trauma treatment and research has massively increased since the invasions of Afghanistan and Iraq. But the military’s recognition of PTSD as a legitimate medical condition wasn’t simply born out of a benevolent desire to help veterans heal. Instead, it arose out of necessity: treatment was a practical response to long conflicts fought in the absence of a draft. Volunteer troops needed to be redeployed as swiftly as possible, leading to a preference for short-term therapeutic approaches and an emphasis on training that could foster “resilience.” PTSD, in this framing, is simply a biological response to extreme experiences—an approach that decontextualizes the circumstances in which traumatizing events occur. In this way, Abu El-Haj argues, “medical science does the work of depoliticizing war.”

Psychiatrists working with veterans in the United States have more recently begun to develop methods attentive to their patients’ complex emotional responses to experiences of combat. Unlike understandings of trauma that treat it as a strictly biophysiological phenomena, the newly popular concept of “moral injury” (Abu El-Haj dates the first peer review publication on the topic to 2009) acknowledges that the traumatized soldier has a conscience, and that they may therefore experience feelings of guilt about their past actions. The model does not simply cast the soldier as a passive victim: it enables recognition of culpability and emphasizes agency. But by positioning traumatized soldiers as professionals just “doing their job”—a job supposedly governed by a clear moral code—“moral injury” does not, Abu El-Haj argues, open up a political space for questioning the justness of the wars that traumatized these veterans in the first place. The acts the job demands the solider perform in the line of duty are recognized as disturbing on an individual emotional level but framed as little more than an occupational hazard. The figure of the traumatized soldier is treated as an “iconic citizen” whose suffering is understood as a noble sacrifice in service of the nation, to whom noncombatant citizens owe a debt of gratitude. By participating in imperial warfare, they’re taking one for the team.

Notably absent from all this, of course, is the other side of the coin: the suffering inflicted by the U.S. military and its traumatic impact on the lives of Afghans and Iraqis. The acknowledgment of trauma on one side goes hand in hand with its disavowal on the other. Must this always be the case? Here Abu El-Haj returns to Lifton to challenge accounts of PTSD that suggest the diagnosis is intrinsically apolitical. His earlier work with veterans of the Vietnam war is significant, she argues, for demonstrating that the figure of the traumatized soldier could be invested with a different political meaning: one that could play an active role in transforming U.S. foreign policy. His “antiwar warriors” underwent a therapeutic process premised on the understanding that their personal healing demanded a political reckoning in the form of trenchant criticism of war, the U.S. military, and the U.S. state. Little wonder, then, that this aspect of Lifton’s approach to trauma has been sidelined by a U.S. psychiatric establishment flush with military cash.

Where Combat Trauma starts from Lifton’s work on “post-Vietnam syndrome” in the 1970s and moves forward into the present, Ran Zwigenberg’s Nuclear Minds begins with Lifton’s research in Japan before moving back into the past. Lifton’s research in Hiroshima looms over Zwigenberg’s narrative in Nuclear Minds, but functions more like a plot device than an object of analysis in its own right. The book opens with a vignette describing Lifton’s initial visit to Hiroshima in 1962. Here, Zwigenberg challenges Lifton’s declaration that no work had been done with Hiroshima survivors prior to his own interviews. In fact, he finds, various studies of hibakusha were made by American and Japanese social scientists between 1945 and the publication of the DSM-III in 1980, after which PTSD became the dominant frame for making sense of survivors’ psychological experiences. Zwigenberg’s discussion of the theories that emerged in this period highlights the global commonalities of approaches to the psychological consequences of war. Japan, West Germany, the United States: all these countries’ scientists were united, he finds, by a tendency to downplay the long-term mental damage incurred by the victims of civilian bombings.

Much of the research Zwigenberg describes was conducted under the auspices of U.S. institutions far from motivated by an urge to help survivors. Instead, they funded research to prepare for potential future nuclear warfare targeting American civilians, part of a broader project to “normalize” atomic weapons and energy. “Hiroshima itself,” he writes, “was seen more as a symbol and a warning than an actual place with actual people and actual suffering.” Indeed, research with survivors sometimes caused them to suffer further. When it was first established to investigate the impact of radiation in the 1946, the Atomic Bomb Casualty Commission (ABCC) was part of the U.S. occupation forces. Survivors were forced to undergo examinations in rooms without interpreters to explain the procedures or their purpose. Japanese women survivors were forced to strip naked, photographed, and subjected to invasive nonconsensual gynecological examinations. These examinations were criticized by the Nisei Japanese American scientist Y. Scott Matsumoto in a manner that Zwigenberg claims showed “an understanding of trauma very similar to our own.” But generally, he argues that Japanese and Japanese American scientists who conducted research with survivors were no more attentive to trauma than their white American counterparts. Committed to scientific detachment, they tended to focus on the bodily impact of radiation and on the social challenges faced by hibakusha in their postwar lives.

Trauma, Zwigenberg repeatedly points out, was not central to the way that the experiences of Hiroshima and Nagasaki were understood: neither by the survivors themselves nor by the various social scientists who studied them. Where trauma was acknowledged, it was generally understood as a temporary condition, the propensity for which could be traced back to childhood experiences that preceded the bombings—an understanding in tune with the then-prevalent psychoanalytically informed notions of trauma. Unfortunately, sometimes Nuclear Minds seems more interested in the fact that scientists did not talk much about trauma than in what they did talk about instead. By structuring his book around the absence of trauma from pre-1980 understandings of hibakusha experience, Zwigenberg paradoxically makes PTSD central to his narrative. But his arguments about the significance of its absence are inconsistent. Was PTSD experienced by survivors of Hiroshima and Nagasaki prior to 1980 without being recognized, named, or diagnosed as such? Or did their experiences themselves—and not only the language they used to describe them—qualitatively differ from what we now call PTSD?

Philosopher of science Ian Hacking famously argued in The Social Construction of What? (1999) that psychiatric diagnoses are distinct from other kinds of scientific knowledge in that human subjects interact with their classifications, producing what he called a “looping effect.” Unlike, say, quarks or plutonium, human beings are objects whose behavior and self-understanding are informed by the descriptions available to them, even in cases where they have symptoms with biological origins. Zwigenberg seems to be taking a similar conceptual approach, declaring first that survivors “were not ‘traumatized’ by their A-bomb experience” and later that their psychological experiences were “not experienced as trauma.” He criticizes contemporary accounts of the research conducted in the aftermath of Hiroshima and Nagasaki for retroactively framing hibakusha experiences in terms of PTSD, citing psychologist Richard McNally, who has described such narratives as “a psychiatric version of the ‘Whig interpretation of history.’” But elsewhere, Zwigenberg seems to advance arguments premised on these very assumptions. In his discussion of sociologist and psychiatrist Alexander Leighton’s work on Japanese American experiences in U.S. internment camps during the Second World War, Zwigenberg writes: “The concept of trauma did not dominate . . . but . . . it was what the researchers were studying.” Leighton’s subsequent studies of A-bomb survivors conducted in Japan, he claims, may not have developed a “systematic theory of trauma,” but experiences of trauma were nonetheless “evident in fragmentary form.” Although Zwigenberg repeatedly says that PTSD is a historical category, he often proceeds as if it were there all along.

For Zwigenberg, Lifton’s significance lies in his participation in the “creation of the category” of PTSD, which in turn functions to connect Hiroshima and Nagasaki to a broader history of trauma as a psychiatric concept. Lifton’s research in Japan, which immediately preceded his work with Vietnam veterans and preceded the publication of the DSM-III by nearly twenty years, is presented as part of a single trajectory leading inexorably to PTSD: “The journey that had begun with the Hiroshima meeting led Lifton to sit on the committee that drafted the entry for PTSD for the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM III) in 1980.”

This claim is nothing if not a little Whiggish. There are significant differences between Lifton’s understanding of guilt among hibakusha, “post-Vietnam syndrome” and the DSM-III definition of PTSD—none of which are mentioned by Zwigenberg. Neither does he discuss the shifts that took place in definitions of PTSD across successive editions of the DSM since 1980, fine-grained distinctions that Combat Trauma meticulously traces. In fact, the concept of trauma is almost completely absent from Lifton’s Hiroshima book, Death in Life. When he does briefly discuss trauma, he is largely dismissive of its utility in the context of Hiroshima, writing that “the concept of traumatic neurosis does not in itself adequately encompass the dimensions of psychological experience imposed by an event such as the atomic bomb.”

Instead, Lifton foregrounds the concepts “psychic numbing,” “symbolic survival” and guilt. Though particularly prevalent among parents who had survived their own children, for Lifton, guilt was not only tied to individual experiences and relationships but concerned social and collective forms of survival. Death guilt radiates (Lifton uses this nuclear metaphor advisedly): the survivor identifies with the dead and internalizes a sense of responsibility towards them, while also struggling with their own position within the destructive world. But by the time the DSM-III-R was published in 1987, guilt was defined as “non-critical.” In the 1994 DSM-IV, it is completely absent. Guilt only re-emerged later in the notion of “moral injury”—an idea, claims Abu El-Haj, that strips Lifton’s original concept of its politically transformative potential. Nuclear Minds cares little for these subtle but tectonic shifts, instead treating Lifton as a cipher for PTSD, which is in turn treated as a diagnosis with a single and unchanging definition throughout its history.

 Zwigenberg’s contradictory arguments seem to arise from his conflation of two related but importantly distinct phenomena: the absence of the category of PTSD before 1980 and American and Japanese social scientists’ persistent downplaying of suffering among Japanese survivors of the atomic bomb. This latter point is perhaps the most convincing and urgent aspect of Nuclear Minds. But by confusing PTSD specifically with psychological distress more broadly, Zwigenberg muffles some of his book’s most interesting observations. In the book’s fifth chapter, he quotes from research conducted by Kodama Aki, the head of a team of mostly female medical social workers in Hiroshima who was herself a survivor:

Since the survivors have psychological problems attributed both to apprehension of radiation disturbances and to social problems resulting from the sudden loss of many family members and the breaking up of their homes, and are affected also by the interaction of those problems, the need for casework has been great. The subjects suffer because they have encountered those difficulties not singularly, but in multiplicity. They fall into agony [kunō], a state of ambivalence [hantai kanjō ryōritsu, or conflicting emotions], and loss of self, and in many cases this leads to misfortune.

Zwigenberg notes her failure to focus on the experience of the blast itself—the original traumatizing event a typical PTSD diagnostician would center—in favor of a focus on how the individual survivor is adjusting to their social conditions in order to overcome their mental anguish. But what did she mean precisely when she described their agony and ambivalence? By reading this source through the lens of PTSD, he emphasizes what it overlooks instead of dwelling on what it actually says. Historians of PTSD, including Ruth Leys, argue that the diagnosis, by focusing primarily on a single traumatizing event in the past, can overlook both the present social conditions in which the traumatized person is attempting to heal and the broader political context in which the original event occurred. These are precisely the kinds of factors Japanese researchers like Kodama foregrounded in their work with hibakusha. It’s also precisely what Lifton foregrounded, too, in his work with Vietnam veterans—a far cry from the dominant definitions of PTSD Zwigenberg sees as representative of the diagnosis as a whole.

Lifton returns in the fascinating final chapter of Nuclear Minds, which discusses how and why politically engaged Japanese social workers were suspicious of his work on Hiroshima. Activists agitating for compensation and welfare provisions for hibakusha emphasized the uniqueness of the survivors’ situation, particularly the physiological impact of radiation. Many social workers were political radicals of the sixties generation who celebrated heroic resistance among survivors, framing antinuclear activism and struggles for recognition as sources of meaning and hence of healing. They likened Lifton’s project to other more straightforwardly extractive U.S. initiatives that conducted research without offering medical or therapeutic treatment. He was also accused of being too neutral in his stance toward nuclear weapons and insufficiently committed to the peace movement. And his theoretical focus on guilt, they argued, was overly fatalistic and failed to acknowledge the therapeutic role of political resistance and struggles for social transformation among hibakusha.

These critiques may not have made their way to Lifton, but his subsequent research would nonetheless end up addressing them. In Home from the War (1973), written in a moment of increased personal political engagement, Lifton developed a more socially engaged understanding of the function of guilt for traumatized people. Abu El-Haj explains that “on the battlefields of Vietnam, survivorship and the form of witnessing to which it gave birth constituted a perverse inversion of post-Hiroshima survivorship,” a phenomena Lifton named “false witnessing.” The atrocities soldiers enacted—killing innocent Vietnamese civilians—were a way of “paying homage to their dead brothers-in-arms in a distorted moral universe.” Rather than confronting the guilt of having survived within themselves, they directed it back at the enemy. Unlike in Death in Life, in Home from the War Lifton identifies two distinct forms of guilt: static and animating. Static, or numbed, guilt leaves an individual feeling “anesthetized from much of life” and unable to confront or work through their past experiences. Animating guilt, propelled by the “anxiety of responsibility,” emerges from “a sustained and formative dissatisfaction with both self and world.” Static guilt looks inward and ossifies; animating guilt looks outward, remains dynamic, and demands emotional softness, linking social reparation with individual healing—an understanding that seems to have much in common with Japanese social workers’ work on the therapeutic value of resistance among hibakusha. For Lifton’s Vietnam veterans, psychological renewal emerged through a collective therapeutic process that then enabled many of them “to bring truths about the war into many corners of American life.” In the case of both Japanese hibakusha turned peace activists and Lifton’s “antiwar warrior” patients, personal and political transformation were intertwined: as Abu El-Haj observes, “healing the self required repairing the world.” Lifton’s revised approach still conceived of both perpetrators and victims as traumatized survivors. But it did not erase the differences between them, nor imagine that each could be treated through one and the same process. Instead, by incorporating criticism of imperial war into treatment, it offered a clear prescription to agents of state violence: trauma will only end when the violence does.

It is this aspect of Lifton’s work that Abu El-Haj compares to the work of Frantz Fanon—specifically, his clinical treatment of French colonial torturers during the Algerian War of Independence. Fanon—whom no one could accuse of equivocating between perpetrator and victim—was, of course, not excusing or normalizing the acts of “naked, excessive, and racialized” violence perpetrated by the people he treated. Instead, he understood his psychiatric work as part of a political struggle to make such violence stop. Judging from Home from the War, it’s clear Lifton thought much the same way.

Some fifty years after their initial publication, it is striking to read Lifton’s writings on “impaired mourning,” “atrocity-producing situations,” and “psychic numbing” at a time when Israeli bombs kill tens of thousands of civilians in Gaza. It would take another essay entirely to parse the contemporary implications of Lifton’s comparisons of Hiroshima survivors and Vietnam veterans to survivors of the Holocaust, or Zwigenberg’s discussion of the absence of trauma from studies of Holocaust survivors conducted by Israeli psychiatrists in the 1950s. In other work, Abu El-Haj (who is co-director of the Center for Palestine Studies at Columbia University) has thought through the links between the traumas of the Holocaust and the Nakba. Though both “foundational narratives,” unlike the Nakba, which is “the foundational ‘tragedy’ for Palestinian nationalism,” the Holocaust is central to the political imaginary of the West and to Western understandings of trauma. Abu El-Haj argues that rather than drawing parallels between Israeli and Palestinian experiences of “suffering and victimhood,” it is instead necessary to challenge the “sacrality” of dominant Holocaust narratives:

I am not denying the enormity of the crime that is the Holocaust. I am arguing that we will never find a political language within which the question of Palestine truly can be addressed, a political language that does not always already accept the order of things that is “Auschwitz,” if we remain within its discursive frame.

Only then, she suggests, might it be possible to ask not just how victims become perpetrators but how the perpetration of colonial violence can be stopped. Only then, in other words, can the psychic distortions wrought by false witnessing—the channeling of guilt and grief into brutality and domination—be cut off and redirected.

The insight that Combat Trauma draws from Lifton’s research, that individual suffering and therapeutic care cannot be isolated from struggles for political change, echoes work by Palestinian psychiatrists critical of PTSD as a diagnostic category for its failure to attend to ongoing forms of brutality—namely, the trauma of occupation. As Palestinian psychiatrist Samah Jabr observed in the aftermath of Israel’s attack on Gaza in 2014, “Traumatic events cannot be banished from consciousness when they are not banished from communal reality. Acknowledging this reality is a social process, beyond the bounds of individual psychotherapy.”

Independent and nonprofit, Boston Review relies on reader funding. To support work like this, please donate or become a member.