The Trip to Bountiful

Death and Dying in “The Trip to Bountiful”

 The Trip to Bountiful is a vignette in the later life of Carrie Watts, an elder southern woman living out her last chapter with her son, Ludie, and daughter-in-law, Jessie Mae, in 1940’s Houston, Texas. The story unfolds as the camera peeks in on the three inhabitants, sharing cramped quarters in their one-bedroom apartment, early in the wee hours of a summer morning. One by one, the three enter the scene, restless from the heat and the gnawing undercurrent of anxiety typifying  their shared, uneventful lives. Ludie emerges first from the couple’s bedroom (separated by curtained French doors) into the common living space which doubles as a sleeping area for “Mother Watts”), followed by Jessie Mae, seemingly reluctant to permit Ludie to savor the quiet company of his mother alone. As the dialogue ensues their relationship dynamics are slowly unveiled.

Mother Watts appears on one hand as coy and child-like, yet on the other, stubborn and determined. Ludie is hen-pecked by his pushy and domineering, pestering yet sensitive wife, whose disdain knows neither boundary nor restraint. In many ways the story of their lives is a story of their deaths, particularly with regard to the subtle ways that people die from moment to moment through small gestures of concession made in good faith to alleviate tensions constraining their most intimate alliances. Living in such close quarters puts everyone on edge, but each character in this story has their own singular unresolved crisis contributing to the blanket of doleful anxiety that knits their lives together in common.

For Jessie Mae, her dying to self is packaged in the frustration she feels for having settled for far less than she felt she deserved in marrying Ludie. She likes the finery of clothing and hair styles, and the fact of the matter is there is not enough money to support her champagne tastes. Throughout the first scene she repeatedly hassles Mother Watts about the pension check that has not arrived on schedule, blaming her for losing it, or putting it somewhere and forgetting where that might be.  Though not consciously preoccupied with physical death per se, Jessie Mae’s protestations and complaints rather indicate a desire to avoid sliding down into the dreaded toothy jowls of homelessness and insecurity: a sure fire death for an ego as fragile as hers. Ludie is a defeated man, struggling to maintain his employment status while living with the unresolved pain surrounding the death of his grandfather (which is reviewed later during the film’s climactic moment).

The main theme of the movie revolves around Mother Watts’ desire to return before she dies to the hometown and the homestead she has not seen for twenty years. Bountiful, the town where she grew up, is where she buried two babies and raised her son Ludie. She dreams of the day she could go back and “get her hands into the soil again”; to visit her old childhood friend Callie Davis, and “see Bountiful one last time” before she dies. Repeated attempts to realize her dream are foiled time and again by Jessie Mae’s persistent interference, but Mother Watts finally escapes one day unimpeded. With only a small tote bag, purse, and her prized pension check tucked secretly into her bosom, she steals off to the bus station, and on to the bus. 

During the bus ride she makes the acquaintance of a young woman, Thelma, who is dealing with her own death concerns. As it turns out, she is on her way back to stay with her parents, and await her new husband’s return from a World War II tour of duty overseas. The conversation they share during the bus trip focuses on themes of loss, faith and disappointment. The dialogue leads to a tearful fugue of reminiscence of the early days growing up as a young girl in Bountiful, and how Mother Watts laments that she could not marry the man she truly loved, and who loved her, because of class differences. Because she was a poor farm girl, while he was of the merchant class, their love could not be realized and she had to settle for an untrue love. As she recounts the situation, she cries, perhaps for the first time, to release her deep dark secret to the compassionate receptive ears of someone willing to share the burden of a lifetime of grief; someone who would understand her loss and her need to mourn, freely and finally, the death of that piece of the past that occupied her heart space for so many long years.

The town nearest Bountiful is twelve miles away, and because Bountiful is so decrepit now, it is vacant, deserted. Still, since the story is relayed over the backdrop of the Spring season, its pastures, in stark contrast to the themes of loss and death, are in full blossom. These juxtaposed dynamics confirm rather than disavow the credibility of the story, because in the affect of it, we are reminded, even as death elbows its way to the forefront of consciousness, that hope is alive and well, busy springing eternal behind that shimmering veil. The bus arrives and drops her off, but by now it is early morning once again, and there is no transportation available to drive her the twelve miles to her final point of arrival. She decides to rest on the bench and wait until dawn, at which time when she plans to hire a car to drive her there. In the meantime, the local sheriff has received word about Mrs. Watts and when he locates her at the bus station, he informs her that her son and daughter-in-law are on their way to take her back to Houston. Now her anticipation is killed and her anxiety and disappoint peaks – she has come this far, only to be forced in the end to turn back. She won’t be able to realize this one last dream. She begs, pleads, and negotiates with the officer to please drive her the last twelve miles to Bountiful.  She gets herself so riled up, she has one of her ‘sinking spells’, becoming light-headed with blood pressure rising. He takes pity on her, yet feels it important to have her condition checked by the local doctor. (Considering that even at this point during the 1940’s heart disease is the number one cause of death in the United States, adding the ‘weak heart’ attribute was an effective device for heightening the tension for viewers of the film). After the town doctor examines her, making certain she not at risk for heart attack or death, he gives approval, and the sheriff decides to honor her request.

In the text The Last Dance: Encountering Death and Dying (DeSpalder and Strickland) the authors quote a source stating “one of the most important and unique aspects of human experience is the awareness of one’s own mortality” (p. 24).  This seems to be true of Carrie Watts who appears to have resolved the tensions one would naturally encounter in their final life stage. Having arrived at a point of realizing her fullest potential while honoring her life’s limitations, she accepts the fact that her resources, now spent, are beyond revival, and what’s left to accomplish is a panning review of her life efforts. Having justified the moral quality of her existence, she now desires to make peace with the ghosts of her past. Her attempt to return to Bountiful is a curtain call of sorts, beckoning her return to her roots, back to the same dust that was the substance and sum of her entire life, and in this sense she is already ‘living with an awareness of death’. Bountiful was the place that framed her most relevant life episodes, and encapsulated all her life seasons and cycles. It was the source of her psychic birth, and for her to come full circle, she needed for it to become the place of her psychic death. A return to Bountiful would provide her with the perfect place to ‘contemplate the basic questions’ of her existence that humans face as they near the end of life’s road (p. 25).

            Relevant to religious elements of thanatology in ‘The Trip to Bountiful’, Mrs. Watts, as a devout Christian formed in her youth by Bible Belt culture, has a strong devotion to hymns. The director chose the hymn “Softly and Tenderly”, weaving it like a strand throughout as a backdrop of the movie:

Softly and tenderly Jesus is calling, Calling for you and for me;
See, on the portals He’s waiting and watching, Watching for you and for me.

Come home, come home, You who are weary, come home;
Earnestly, tenderly, Jesus is calling, Calling, O sinner, come home!

Time is now fleeting, the moments are passing, Passing from you and from me;
Shadows are gathering, deathbeds are coming, Coming for you and for me.

This hymn parenthetically frames the context for the entire movie, and underscores its themes of homecoming, shadows gathering, deathbeds coming, and this is precisely brought to bear in the movie’s final scene.

            Contentedly, Mother Watts arrives at the doorstep of her precious Bountiful. She stands in front of it, assessing its current status: doors and windows now gone, empty of furniture, leaving a mere skeleton of a structure. Stepping into the empty house, Mother Watts surveys the now bare floors and walls. With her finger she retraces old scratches in the woodwork, and slides her palm across the dusty shelf of the mantle ledge imagining earlier times and remembering the objects that used to occupy the now empty spaces.

            Jostled from her reverie by the sound of Ludie’s voice calling ‘Mama! Mama!, Mother Watts goes to the porch and greets her son with sheepish face of a child caught with her hand in the cookie jar. “How do you feel?”, Ludie asks. “I feel much better son …. I got my wish!”. Once apologies are offered, the conversation turns to topics of the day, and Mother Watts, through misty eyes and averted glance relays how she just found out her young girlhood friend Callie Davis died the other day before she arrived. The funeral had been held the day before. Ludie apologies for not having brought his mother to Bountiful much sooner, stating that he just ‘thought it would be easier if we didn’t see the house again’. Mother Watts pushes past his denial saying, “Now that you’re here, don’t you want to come inside and have a look around?” Ludie declines saying “I don’t see much use in it; I’d rather remember it like it was”, implying that there was something unresolved from the past that he’d rather leave buried there. When Mother Watts asks Ludie if he remembers her father, Ludie launches into a tirade about how he remembers at age ten when he died and his grandfather’s best friend took him to his knee and told Ludie how his grandfather’s life was a real example to follow. Ludie’s grieving grandmother made him promise that when he grew up he would have a son and name him after his grandfather. However, Ludie did not have any children and he felt both ashamed that he was never able to keep that promise and that he never had any children at all, even though his friends went on to raise families themselves. This underscores the disappointment he must have carried throughout his entire life that he failed to measure up to an expectation set upon him at an earlier time of his life. However, a young boy could never predict how the vicissitudes of life would serve to interfere with even the best of intentions to fulfill those expectations. And so in this regard, the trip to Bountiful not only served Mother Watt’s need to find closure, but also the need for her son to find resolution and reconciliation, two themes that are present in thanatology as requirements for resolving the anxiety that surrounds death, ultimately leading to new paths of healing and hope.

            The story of The Trip to Bountiful was a shining example of Robert Kastenbaum’s Edge Theory and its Continuum of Awareness and Denial. Mother Watts, wanting to embrace the past, was situated on the Awareness pole of the spectrum, while Ludie leaned more toward the Denial end, as evidenced by his desire to avoid facing the past. What this movie shows us is that it is futile to resist the inevitability of death. That the sooner we recognize and accept that life, as the song says, is ‘fleeting, its moments passing from you and from me’, the sooner we can learn to welcome the inevitability of our own demise, and begin to cooperate and make peace with the process, rather than treat it as an eventuality to be denied and avoided. 

Regarding Caveman Masculinity: A Rant

 Inspired by a reading of McCaughey's "Caveman Masculinity "

It's all a capitalist's game and depends on who is selling what …..and what we are being sold mainly is a ticket to the nearest point of sale. I really don't want to come across as cynical; it is a capitalistic society after all but people's fears are constantly being exploited by those who have the economic capacity and resources to do so. We are buying what is being sold because we desparately feel the need to be accepted. It's human nature. There's something about the need for nurture that blinds us to this fact, (like a person in the throes of passion who forgot the birth control and in a frenzied moment of impassioned denial casts their fate to the whim of the moment). And because we exist in a society that moves at such a fast pace, where split second decisions are being expected constantly of consumers, when forced to decide we do so impulsively, without stopping to allow rationality to eclipse immediate gratification. This is what the marketplace is all about (….sorry business majors!) and, note to self, there is no use lamenting the moral implications of exploitation because this is America after all, and our ethic is such that we celebrate social Darwinism as the ultimate prize. Those who have the means to do so are within their right here to do whatever they choose within legal reason. When DuPont figured out a way to  create a sensation by mass producing silk stockings at a price level that even lower income women could afford, we bought into their image making money scheme. It wasn't so much that they were selling stockings as much as that they were selling 'class' , and doesn't everyone want to appear 'classy'? Doesn't everyone want to appear socially, biologically, intellectually relevant? And along with the class comes status and elevated status translates into more power  and more power translates into more opportunity and more opportunity translates into different things depending on the defined goals for the particular gendered class an individual subscribes to.

If you are male, your status/power is linked with your ability to trump the powers/status of the next male.  (Correct me if I'm wRONg but the same seems likely to be true for females also). In our civilized society today that means being a well trained caveman in intellectual form, savvy, physically 'hot', unbeatable: a winner in all realms of being: a superman! How is this different from the caveman in the earlier stage of evolution? Is it different or is it really same thing in a different wrapping? Because when it all boils down to the ultimate display of power, i.e., the arena of fisticuffs, it does not really matter if you have a penis or not (I tried to think of another way to say that, but saying "having a vagina or not" does not convey the same message! ….that in itself could be an entire topic of discussion). What does matter is who can kick whose ass in the arena. And those that can triumph there get the "prize" ….. what is the prize? Again it all depends on what satisfies one's self interest. Female or male, how do I get my needs met? And where do 'needs' come from? Are they fabricated like 'wants' are? Or are they hard wired in as part of the survival instinct. I think that's the ticket. Needs are inborn, and wants are constructed according to the popular devices and mechanisms that are the product of a given socioeconomic current.

Debunking Gender Codes: From Deviance to Variance

Introduction

The Encyclopedia of Behavior Sciences specifies the core concepts of Western humanism as being identity, science, truth and authenticity [¹]. And out of the impulse to define the cultural relevance of these concepts as articulations of current social theory, normative identity movements have arisen to challenge the structuralist ideologies that produced them.

The main purpose of these identity movements was to transform society in such a way as to more accurately reflect individual interests and world view. For a movement to occur there needs to be a sense of common identity or purpose, and sufficient political/economic space to mobilize the movement. This was apparent in the labor rights movements and women’s suffrage movements of the late 19th and early 20th century. Ultimately, the fermentation of these efforts resulted in a variety of movements midwived by the Civil Rights Era. Beginning with racial freedom, women’s rights, and liberation from repressive binary sexual and gender strictures, its repercussions unleashed an avalanche of social upheaval, resulting in the American Psychiatric Association voting to remove the stigma of homosexuality as a mental illness from the Diagnostic Statistical Manual in 1973. Though much to the chagrin of the moral majority, this identity movement cut a swath which paved the way for a new path of the social deconstruction process, birthing the emergence of Queer Rights social action and advocacy groups. And thus the struggle with “gay rights” began, fueled by the conflict that arose between moralists and their rivals, the liberal thinking Americans who wanted nothing less than the same constitutional protections guaranteed all citizens: the right to life, liberty and the pursuit of happiness.

After gay liberation began to build momentum in the United States there was no stopping the movement, as this fledgling identity movement galvanized a cohort to work incessantly to modify social norms that affect individual’s private, civil, and professional lives. Today the movement’s initiatives aim for acceptance of differences and want to change social stereotypes. These differences are of a sexual, intellectual, or physical nature, such as sexual orientation, whose participants feel that they are the victims of prejudice.

            However, as the movement evolved and as research would eventually indicate, it became obvious that sex and gender were really two different aspects of a very complex subject. What had been formerly thought as ‘deviant behavior’ ultimately became accepted and embraced simply as naturally occurring aspects of human character that not only were beyond control, but that in fact were greatly misunderstood, and fascinating components of being human.

The Rise of Queer Theory: Evolving Trends in Gender Variance

Prior to the eventuality of the APA’s removal of homosexuality as a disorder, people who did not fit into nice neat binary categories either stayed hidden, or gathered in secret societies and social clubs that would never have been considered worthy of inclusion in a Norman Rockwell gallery depicting vignettes of mainstream society. Mainstream society had been groomed to reject with suspicion and disgust appearances of non-gender normative social models. As such, there were no visible Modern Day families, no Will and Grace, no Angels in America, and definitely no Queer Eye for the Straight Guy. Prior to the Civil Rights Movement, words and ideas like fag, dyke and queer represented the worst social stigma known to society. Deemed worse than wife beaters, murderers, and rapists, non-traditionally oriented folk were considered deviant, the lowest of the low, on par with child molesters.

However, the removal of homosexuality from the list of mental disorders in the mid 70’s dramatically changed the tenor of public discourse around topics of sexual orientation and behavior. Changes in clearly defined gender roles and characteristics began to be reflected in appearances of unisex hairstyles and fashion, erasing the boundaries that reinforced the assumptions of binary gender identification and expression. Once public silence had been broken on dialogues surrounding the mystique of non-hetero normative social and sexual practices in American culture in the 1980’s, a new wave of intellectual curiosity arose concurrently, taking the form of what came to be regarded as Queer Theory. According to the Encyclopedia of Behavior Sciences [¹]

‘Queer theory’ is a theoretical movement with political counterparts that is in constant flux and development, and is characterized more by what it challenges and contests than by what it offers in the shape of a unified social theory. It draws on the work of theorists such as Eve Sedgwick and Judith Butler.  Queer Theory ‘describes those gestures or analytical models which dramatize incoherencies in the allegedly stable relations between chromosomal sex, gender and sexual desire (Jagose 1996). In this sense, queer theory is a challenge to the obvious categories (man/woman, butch/femme), oppositions (man vs. woman, heterosexual vs. homosexual), or equations (gender/sex) upon which conventional notions of sexuality and identity rely’ (Hennessy 1993). Queer theory argues instead that sexual desire and sexual practices are not reducible or explicable solely in terms of identity categories, such as gender, race, class, or sexual orientation. It is radically anti-essentialist, in that it challenges a notion of homosexuality as intrinsic, fixed, innate, and universally present across time and space. Queer theorists reject any mode of thought that relies on a conception of identity as unified and self-evident (e.g., I have sex with people of. the opposite sex, therefore I must be heterosexual), and instead demonstrate that desires, sexual practices, and gendered identities are performances and enactments, rather than expressions of ‘true’ subjectivity. Heterosexuality is therefore challenged by queer theory not simply as a ‘hegemonic’ mode of identity, but as a false claim to unity and coherence that is constantly undermined by the incoherencies of sex and gender, incoherencies that the queer analytic hopes to expose and celebrate.

Since the early 1990s, ‘Transgender’ as a term has emerged rapidly in the United States to describe someone assigned to one gender who, in one respect or another, does not perform or identify as that gender, and has taken some steps, temporarily or permanently, to modify parts of their person in order to align themselves more authentically with their self-perception. The emergence of ‘Transgender’ has been shown to be evident in journalism, in popular media representations, in both legislative and academic settings, and in both advocacy and activism.

David Valentine, anthropological ethnographer and author of Imagining Transgender [²] (pg. 33) writes about how the institutionalization of transgender as a category was shaped by the convergence of several intersecting contexts, including those of public health, social services, academics and legislative realms. In his research, he found that many of those labeled transgendered by activists did not know the term or resisted its use. Instead, he reports, they identified as “gay”, a category of sexual rather than gender identity. In analyzing the differences between these two categories he rejects the conflation of these two categories as being contextually similar, and instead points out the distinctions between them.

Sexual orientation speaks more of specific behaviors engaged in by particular persons, whereas gender orientation speaks specifically about the manner in which a person expresses their psycho-emo-spiritual inclinations irrespective of their sexual inclinations. Sexual orientation belies the attractions that people have toward certain others relative to either character or genital attributes (or both). The concept of Transgender essentially separates the biological/sexual component from the psychic component, and removes the collectivism that in the past had drawn direct lines of association between sexual behavior and gender expression. No longer is it applicable to assume that because one’s gender is the opposite of their biological/genital appearance, that they are ‘gay’. Nor is it appropriate to assume that because they self-identify as “straight” that they are only inclined to engage in sexual behaviors with their binary opposite.

On the other hand, Transgender dissolves the idea of collectivity, and divides the categories of sex and gender into sorting bins that differentiate the two classifications as distinct and separate aspects of personhood. The old notion that those who do not conform to societally constructed ideas about gender norms are exhibiting ‘deviant’ behavior is replaced with non-stigmatizing language that affirms all gender expression as equally valid forms of variance. The general idea is this: a Transgender person is any individual who finds themselves left out of society’s usual gender roles. The term “Transgender” does not necessarily invoke any particular sexual orientation. Transgender people may identify as gay, straight, bisexual, or anywhere in-between [4].

Advocacy and Activism: Sprouting Wings

            In terms of Advocacy and Activism on behalf of people who have been marginalized and discounted as a result of their non-conformance to socially sanctioned gender codes, initiatives have formed through subsequent decades consequentially protecting and defending constitutional rights as citizens of the United States. These efforts to secure equal rights have served individuals on a variety of levels.

            On the individual level, following the removal of the homosexuality from the DSM, with homosexuality no longer perceived as a disorder to be treated and cured, individuals struggling with the internal stress and external pressure to conform, needed no longer deny their authentic natures. Furthermore, since sexual orientation was no longer considered by the psychological and medical fields to be pathological, the treatments took on less a curative approach, and became more supportive and affirming of the individual’s organic mental health process.

            But it was one event in particular that spawned an era of advocacy and activism that would echo far into the future. The Stonewall riots of 1969 were, according to Wikipedia[³] “ a series of spontaneous, violent demonstrations against a police raid that took place in the early morning hours of June 28, 1969, at the Stonewall Inn, in the Greenwich Village neighborhood of New York City. They are frequently cited as the first instance in American history when people in the homosexual community fought back against a government-sponsored system that persecuted sexual minorities, and they have become the defining event that marked the start of the gay rights movement in the United States and around the world”. David Valentine (Imagining Transgender) writes about the influence of Stonewall on the social institutional fabric, stating that, from the perspective of the Stonewall activists, that the pathologization of homosexuality was anathema, and furthermore was seen as central to the broader homophobic structures they sought to overturn (pg. 54). From that point on, gay and lesbian activists adopted a variety of tactics including disrupting meetings of the American Psychiatric Association, picketing events, and engaging in other protests. Their platform sought to change the idea that homosexuality was pathological, and that it was a natural variation of sexual behavior. This timely period coincided with ‘major transformations within psychiatry’ (pg. 55), particularly among those who were opposed to the pathologization of homosexuality. Also, the profession, coincidentally, was beginning to place more emphasis on empirically based research which led to the ultimate removal of homosexuality as a disorder from the DSM.

Subsequently, with the stigma now removed from institutions that usually referred to the DSM to take its cues regarding how to perceive and thus diagnose certain behavioral proclivities, the LGBT community began to gain more credibility, support and political power, as it began to sprout wings, in many realms, political, sociological, legal, and judicial. On the community level, mutual self-help support groups and organizations emerged in the form of LGBT community centers that sought to act as resource liaisons for mediation, service provision, and education to meet the needs of the individuals and their families who were frequently denied services because of their sexual orientation or gender status. These community services often link the individual with legal services, medical services, housing options etc. Colleges and Universities began to affirm LGBT history as a field of study, and created departments dedicated to research, while providing affirming support services for LGBT students and faculty. These types of organizations often work in concert with other local advocacy and activism organizations such as[⁴]:

·      P-FLAG: Parents and Friends of Lesbians and Gays

·      MCC: Metropolitan Community Church

·      HRC: Human Rights Campaign

·      GLSEN: Gay Lesbian Straight  Education Network

           

Finally, the passage of the Matthew Shepard Act ensuring protections against hate crimes for all persons (including sexual minorities) was signed into effect by president Barack Obama on October 28, 2009.

Conclusion

            Our culture from birth attempts to label the individual according to its biological genital characteristics. And thus identities are constructed according the roles that each of the binary categories are assigned.

The conflation of two separate aspects of human lives, gender and sexuality, rely on the belief that sexuality and gender are in fact two separate domains. However, reflecting on the etiology of either, it is probably difficult to prove which began first, or which domain had more impact on the other. Even the earliest psychologists identified sexual behaviors in humans from birth, prior to the appearance of gender specific preferences. Gender is best understood as a construct, but the person does not consciously participate in the construction process until the ego appears in more highly developed form further along its developmental chain. By the time the physical/biological domain catches up with and intersects with the emotional/psychological domain, the result is more likely to be a product of the mix of both domains intersecting and modulating throughout all stages and channels of development.

            In a binary system, there is a tendency to ignore the variety that exists outside the realm of the two extremes. Doing so does a disservice to those who do not fall into a binary category in either realm, gender or sexuality. The world is neither all black nor all white. Each aspect of created being displays a vast array of variance. Why would gender and sexuality be exempt?

            In spite of the obsession with enforced binary codes being transmitted culturally through each succeeding generation, strides are being made to unpack the meaning of gender. And it is the emergence of the idea of ‘Transgender” that is helping construct a new lens through which to identify the subtle distinctions in gender. As scholars and activists continue to elucidate new versions of variance, it behooves us to reach back into the past and reclaim the identities that were once misconstrued as deviant, and in doing so, more authentically redefine who we are in the present, and ultimately construct positive and affirming sexuality and gender frames for future generations.

References

[¹] Encyclopedia of Behavioral Sciences © 2001 Elsevier Ltd.

http://www.sciencedirect.com/science/referenceworks/9780080430768

[²] Valentine, David, Imagining Transgender. Duke University Press,    ©2007

[³] http://en.wikipedia.org/wiki/Stonewall_riots

[⁴] http://www.gaycenter.org/gip

NTAC= National Transgender Advocacy Coalition: http://www.ntac.org/

Nanda, Serena. Gender Diversity: Crosscultural Variations. Waveland Press, Inc. Long Grove IL, ©2000

Vietnam era Veterans and Co-occurring PTSD/S

Historical Experience as a whole and relevance to Social Work practice:

    Vietnam Veterans upon returning home presented the social work community with a variety of issues that required professional level assistance. These issues included homelessness, domestic violence, post-deployment readjustment, and substance abuse to name but a few. In keeping with the NASW code of ethics, Social Workers focus their skills on several areas of competence, but in particular, the Dignity and Worth of the Person, the value and importance of enhancing human relationships as relevant to the issues facing this population.
    Social Work plays a pivotal role in the delivery of services to the Vietnam Veterans. On the micro level, direct practice efforts strive to empower the individual through direct counseling by designing outcomes that advance personal efficacy.
    On the mezzo level Social Work partners with community organizations to broker support networks by connecting clients with medical and mental health services, mutual help groups, housing, and the appropriate social welfare programs designed to meet their needs.
    Macro level focus includes broad community planning, coordination, advocacy and integration of services on the federal, state, county and local levels. Social Work, because of its leadership, flexibility, and commitment to "Putting Veterans First", continues to thrive as a profession in the current health care environment.

Vietnam Veteran History of Advocacy    

Vietnam Veterans of America (VVA) is the only national Vietnam Veterans organization congressionally chartered and exclusively dedicated to Vietnam-era veterans and their families.
      By the late 1970s, there was as yet no legislation to address the needs of this particular segment of the Veteran’s population. In January 1978, a small group of Vietnam veteran activists came to Washington, D.C., to rally support for creating an advocacy organization devoted exclusively to the needs of Vietnam veterans. VVA, initially known as the Council of Vietnam Veterans, began its work. At the end of its first year of operation in 1979, the total assets were $46,506.

Addressing Congress, council members hoped to gain political support for creating supportive policy and programs to meet the specific needs of Vietnam veterans and their families. However, despite persuasive arguments before Congress, they failed to win even a single legislative victory. It became apparent that social justice arguments made by a small group alone would not be sufficient. The U.S. Congress would respond to the legitimate needs of Vietnam veterans only if they had political strength. Following an intensive strategic membership drive, the Council of Vietnam Veterans by 1979, had transformed into the service organization Vietnam Veterans of America.
Building further upon its advocacy successes, in 1983, VVA founded its associate legal services department, the Vietnam Veterans of America Legal Services (VVALS) organization to broker on behalf of Vietnam veterans seeking benefits and services from the government. Over the next several years VVA grew in size, stature, and prestige. VVA's professional membership services, veterans service, and advocacy work gained the respect of Congress and the veterans community. In 1986, VVA's exemplary work was granted a congressional charter, formalizing its legitimacy.

VVA’s mission is to promote the educational, economic, health, cultural, and emotional readjustment of the Vietnam-era veteran to civilian life. Relative to these goals, the organization’s practice skills are directed toward three realms: lobbying, mobilizing constituents, and engaging media support to realize its agenda. Legislative victories establishing the Vet Center system, passage of laws providing for increased job-training and job-placement assistance for unemployed and underemployed Vietnam-era veterans, laws assisting veterans suffering from Agent Orange exposure, and landmark legislation (i.e., Judicial Review of veterans claims) permitting veterans to challenge adverse VA decisions in court. All were enacted largely as a result of VVA's legislative efforts. Though much has been done, there is still so far to go to address the unmet needs of this population.

Comprehensive review of the literature about Vietnam Veterans and Post Traumatic Stress Disorder and Substance Use Disorder
 
The Vietnam War recalls the controversial treatment of veterans when they returned home, and the abuse encountered upon arrival only added to the already damaged psyches of many of the vets.  “Only the veterans of Vietnam have endured a concerted, organized, psychological attack by their own people” (Grossman, 1996, p. 280). This was the first time since the advent of televised media, that coverage of a war would inflame such a virulent public response. After the war subsided, eventually, the problems veterans were having post-deployment as they transitioned back to civilian life became self-evident.  However, it was not until 1980 that the term Post traumatic Stress Disorder became the branding that would identify this specific cluster of symptoms as a formal diagnosis in the Diagnostic Statistics Manual. 
    The DSM-IV-TR describes a traumatic stressor as “involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one’s physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate.” (American Psychiatric  Association, 2002, p. 463). It must involve a response of “intense fear, helplessness, or horror” and the resulting symptoms are what characterizes PTSD.
    The consideration of PTSD as a new diagnosis did not occur until many years after the Vietnam War veterans had returned home and tried to bring attention to their issues.  Even in 1980, there was still much to learn about Post Traumatic Stress Disorder.


In May of 2001, a comparative study done by the Department of United States Veterans Affairs released data on the Socioeconomic Status of Veterans and on VA Program Usage. This study compared veterans and non-veteran counterparts on several measures of socioeconomic status.
    Conclusions drawn from this study show that there were several contributing risk factors at play for Vietnam Veterans who were later diagnosed with PTSD following their release from combat duty. These include socioeconomic disadvantage, low education level, unemployment status, and poverty level and substance use. Education level seemed to figure prominently in that veterans with lower levels of education had a greater risk for mental health problems following exposure to trauma. Low education attainment when coupled with drug and alcohol usage increase potential for post traumatic stress disorder among veterans exposed to combat trauma.
    When considering the before and after profile of a young man who was enlisted during the time of the Vietnam War era it is helpful to take into account these social ecological factors contributing to shaping the pathway to post traumatic stress disorder.  This is  supported by the research done on Vietnam Veteran’s relative to the onset of post traumatic stress.  Soldiers who started using drugs during high school for recreational purposes would be most likely to continue engaging in the practice, however, under duress of active combat duty, the utility would shift from mere recreational usage to substance abuse in order to escape feelings associated with psychological distress associated with trauma. Therefore, they would likely become candidates for the progression of the disease and its later stage development into a state of disorder. At the time of this study, in the year 2001, those who were age 54 years of age at the time, would now be 64, well within the age range of those who had served. Upon release from the service, unaware of the progressive and debilitating nature of substance abuse on all the organisms health systems and sub systems, it is unlikely that those who returned to normal lives as civilians gave up the practice of use of substances to numb psychological pain. Discharged, addicted, and traumatized, their continued use only served to reinforced the advance toward disorder. 


The impact of military service on long-term health is reemerging as a vital policy question, particularly as the United States conducts concurrently several major military operations. Health professionals, based on findings of years of ongoing research projects specifically aimed at Vietnam Veterans note that significant numbers of retired military personnel representative of this era are experiencing problems that are detrimental to both their psychological and physical health.
    Substance abuse has become, among others, the primary coping mechanism for Vietnam Veterans who suffer from unresolved Post Traumatic Stress relative to commonly co-occurring diseases. For example, in one of the early papers in this literature, Card (1987) finds that Vietnam Veterans are much more likely to report problems associated with post traumatic stress disorder including ‘‘nightmares, loss of control of behavior, emotional numbing, withdrawal from the external environment, hyper-vigilance, anxiety, and depression.’’ Later, Jordan et al. confirm this finding (1991), further documenting that “exposure to combat in Vietnam is associated with higher prevalence of specific psychiatric disorders, including post traumatic stress disorder”. Dobkin and Shabini present evidence of a strong link between post traumatic stress disorder and substance abuse (The Health Effect of Military Service: Evidence for the Vietnam Draft, 2007) In “Vietnam Combat Veterans: Treatment Problems, Strategies and Recommendations, by J. Michael Murray, MS, and Tom Williams, PsychD,  the authors, who are themselves Vietnam veterans have interviewed or treated more than 2,000 combat veterans and their families and have found that 80% of the veterans seen have had alcohol related problems, further supporting the evidence presented by others, that these disorders are often correlated. 

 
The topic of Trauma, PTSD, and substance abuse are co-related according to the article titled ‘Post-traumatic stress disorder, drug dependence and suicidality among male Vietnam veterans with a history of heavy drug use” (2008). According to this article, generally speaking, PTSD and substance abuse problems are often diagnosed together.
    In the general population, up to three quarters of those who have survived violent trauma report substance abuse problems. Comparatively, 60-80% of Vietnam Veterans need of treatment for co-related diseases of PTSD substance abuse. Veterans over the age of 60 with PTSD are at higher risk for a suicide attempt where substance abuse and dependency problems co-exist with depression.  The significance of these findings are such that they indicate practical and clinical implications not only for the well-being of the veterans themselves, but for family members and the health care system at large.


The Practical Implications: different types of trauma result in the syndrome of PTSD, and the disease will manifest itself uniquely for each individual, since each individual has unique endogenous and exongenous variables impacting his circumstances. This implies that there is no single solution for treatment, and assessments will require interventions that often extend beyond the ken of a single discipline’s scope of field. Those in the mental health and medical services delivery field who will come in contact with these individuals will need to apply a psychological diagnostic skill set that incorporates a combination of substance abuse and recovery therapy, direct counseling services, group work, and family counseling, in addition to medical interventive techniques.
    Clinical Implications: The burden on the health care system is even larger when comorbid substance abuse exists (Virgo et al., 1999; Piette et al, 1997). Patients with both PTSD and SUD (substance use disorder) have a more severe clinical profile than those with either disorder alone The challenges across medical and psychological disciplines will require purposeful planning and building of therapeutic alliances that serve the intersecting health needs of this population. Practitioners in the Behavioral, Neurobiological, Medical disciplines must be integrated simultaneously to counter previously held assumptions that beginning trauma therapy before reduction or elimination of substance use will lead to an increase in substance use. This has not been found to be the case at all.  (Towards Integrated Treatments for PTSD and Substance Use Disorders, Suzy B. Gulliver, PhD (Director, Center of Excellence for research on Returning War Veterans, Waco TX ) and Laura E. Stoffen, BA. 

..........Social Workers have done much to support the needs of this population, however, much more can be done to help this population become a more visible and viable segment of the local community. By treating the community itself as a target system, Social Workers can team with other community social organizations and mental health and medical service professionals to advocate on behalf of Vietnam Veterans by creating community outreach programs to raise awareness and educate the community about the plight of the population.These advocacy groups could identify gaps in services/resources and put into effect systems changes that are responsive to veterans’ changing needs.
    Efforts at inclusivity include; inviting local Vietnam Vets organizations to participate in community picnics and parades, by hosting community events such as bingo’s, spaghetti dinners and fish fry’s, teaming them with local Boy Scout organizations in order to provide role models and good PR for future military involvement; this and similar activities will help this population establish a niche as a visible and important presence in the community.
      By breaking down the invisible curtain that separates this population behind a veil of mystique, social workers can help mediate the process of mainstreaming the population into the larger culture.

References

• Post-traumatic stress disorder, drug dependence, and suicidality among male Vietnam veterans with a history of heavy drug use,  Journal of Drug and Alcohol Dependence 76S S31–S43. Rumi Kato Price et al. © 2004
• Post-Traumatic Stress Disorder and Substance Abuse in Vietnam Combat Veterans: Treatment Problems, Strategies and Recommendations. Journal of Subsrance Abuse Treatment. Vol. I, pp. 87-97.19.  J. Michael Jenlinek, MS,Tom Williams, PsyD ©1984
• Civilian Social Work: Serving the Military and Veteran Populations, Savinsky et al, 2009.
• Websites Referenced:
• United States Department of Veterans Affairs National Center for PTSD: http://www.ptsd.va.gov/public/pages/ptsd-alcohol-use.asp
• Substance Abuse and Mental Heal Services Administration (SAMHSA)
• http://www.samhsa.gov/MilitaryFamilies/
• http://www.oas.samhsa.gov/aging/chap9.htm: Utilization of Veterans' Health Services for Substance Abuse: A Study of Aging Baby Boomer Veterans Brenda M. Booth,* Ph.D.,
• Frederic C. Blow, Ph.D.
• National Survey on Drug Use and Health (NSDUH) http://www.oas.samhsa.gov/2k7/veteransDual/veteransDual.htm

Adolescent African American Males at Risk for Incarceration

    The charge to investigate how the underground economy and black male incarceration rates affect black males, their families, and the black community as a whole, has created an opportunity for enlightenment, specifically as it regards the factors that facilitate the circumstances under which this phenomenon occurs. 
    Taking into account the barriers of access to opportunity experienced by black males in economic and educational realms it stands to reason that, failing normal avenues of access,  an individual would fabricate, by any means available, the necessary pathway to survival.  It should come as a shock to no one that when jobs are scarce, people turn to alternative forms of “employment”, asserting their own ingenuity in order to do whatever is necessary to ‘make ends meet’.  Restricted from access to regular means of employment, black men in particular, in many cases, having been forced to accept the alternative, ultimately surrender to the only remaining option: a life of work that is “off the books”.
    Unfortunately the paucity of the situation did not begin with the inability to find a job. It began much sooner than that; it began with a breakdown somewhere in the educational system, a system rife with institutionalized racism, prejudice and discrimination. A system dominated by a perspective that underestimates the young black male student on all accounts. A system that ignores his potential contributions as inconsequential. A system that has failed him in the most important stage of his life, the one where, all things being equal, he would be given the necessary foundational tools ensuring his ability to compete in a legitimate marketplace.
    Ill-equipped and without the proper and necessary tools, he becomes bored, and shiftless, turns to recreational drug use, which further dulls his ambitions and destroys his dreams. When he does engage himself in the act of labor, it is often in an underground economy of some sort. He shovels snow, or mows lawns or runs errands for neighbors in order   to acquire a bit of mad money to cover the cost of cigarettes, and maybe a little bit of marijuana. Eventually, he turns from smoking drugs, to selling drugs, from washing cars, to stealing cars; from working at CoGo’s to robbing CoGo’s, from dating women, to selling women.
    Young, school drop out, underage, his life is now set, and he is doomed to repeat the cycle of adjudication and incarceration. This is the portrait of the young black male who is featured in the study that I did as an attempt to develop a profile of young Black adolescent males who are at risk for becoming incarcerated in the Criminal Justice System in their adult lives. As part of this study, 15 young Black males who are currently adjudicated as delinquents in Allegheny County Court system were solicited to voluntarily participate in an interview regarding certain aspects and influences impacting their lives. This interview was designed to serve as a non-scientific ‘pre-test’ for predicting potential future incarceration statistics. The questions asked in the interview were classified as two types: Objective and Subjective.
    The Objective set were of two types: 'yes or no' type questions, and other questions that asked about relationship dynamics. For example, they were asked about the expectations that were placed on them by their guardians, and they were asked what were the values that their family systems held dear. They were also asked their opinions about the importance of education and they were given the opportunity to rate the value of education on a 1 to 10 scale. They were asked to specify the behaviors that led to their adjudication and detention. They were asked about their drug use, sexual activity, parenthood status, and they were asked if they had relatives or friends who had been or who currently are incarcerated. The answers were assigned +/- values, and the scores were tallied to project which dynamic would likely have greater influence on their future life's course, if nothing happened to intervene and cause them to change direction.

Question Set #1 (Objective type)

Q2        2. How do you get along with those you reside with?
Q5        5. Do you have contact w/ parents?
Q6        6. Relationship w/ mother?
Q7        7. Relationship w/ father?
Q8        8. Relationship w/ authority ?
Q9        9. Family members involved w/legal system?
Q10        10. Friends involved w/ legal system?
Q11        11. Family members incarcerated
Q12        12. Victim of abuse?
Q15        15. On Welfare?
Q16        16. Charged with crime?
Q17        17. Ever shot anyone?
Q19        19. Family currently involved with CYS?
Q22        22. Suspended or expelled?
Q23        23. Diagnosed special needs?
Q25        25. Runaway from home?
Q26        26. Do you smoke?
Q27        27. Used drugs or alcohol?
Q28        28. Sexually active?
Q29        29. Tattoos or piercings?
Q30        30. Fathered any children?
Q31        31. Have you ever been hospitalized in a mental health facility?
Q32        32. Ever been diagnosed w/ depression?
Q33        33. Do you take medication to control behavior?
Q14        14. Own or rent?
Q18        18. How old at first contact w/ legal system?
Q20        20. How old are you?
Q21        21. Grade placement
Q24        24. Currently employed?
Q34        34. On a 1 to 10 scale, rate education

    The graphic chart figure 1, reflects aggregate data collected on these questions. The  bars in the positive range represent the number of positive values assessed, and the bars in the negative range represent the number of negative values assessed for each question in the Objective Set. (R1 + = the positive values reported for Respondent 1. R1 - = the negative values reported for Respondent 1, and etcetera). By looking at this information, one may ascertain the dominant dynamic forces influencing the individual’s life, either positive or negative, and thus recognize them as strong risk factors for predicting probability of increased risk in the future. 

(fig. 1)
    








The other set of questions were more informational and subjective. These asked about their age and level of education, their goals for the future, and the perceived barriers to meeting them.      Each question on the list was assigned either a neutral, positive or negative value for use in assessing the overall environmental and peripheral dynamics impacting on the formation of the young man's character. Positive influences were assumed to identify tendencies leading to functional behaviors, and negative or indifferent influences were assumed to identify influences that may possibly contribute to maladaptive social pathologies.   

Question Set #2 (Subjective and Informational)

    I feel it important to share the answers to these specific questions because they are pertinent to the subject matter, particularly regarding the types of household configurations of Black American Families, and because of the values, hopes and aspirations of this ethnicity.
   
    The choice of questions that would be included in the interview emerged from the concepts studied in our course content that served to illuminate the risks and resiliencies of the Black American Family. Certain questions were designed to reflect attributes that are historically characteristic of the Black American Family experience. For instance, the interviewees were asked to disclose their family structure. Their descriptions reflect those structures exemplified in the Billingsley text (Climbing Jacob’s Ladder, Chapter One).

Q1     List the people in your household

R1    6        mom, 2 brothers, sister, cousin; another sister lives in Phila w/ father
R2    4        mom, father, sister
R3    3        grandmother, father
R4    4        mom, stepfather, brother
R5    3        mom, stepfather
R6    2        mom
R7    2        mom
R8    7        mom, stepfather, sister, brother, 2 cousins
R9    3        grandmother (legal guardian since birth), aunt
R10    10        mom, stepfather , 2 brothers, 3 sisters, stepbrother, stepsister
R11    3        mom, brother
R12    6        mom, 2 brothers, 2 sisters
R13    5        mom, 3 sisters (live in shelter)
R14    4        mom, father, brother
R15    2        mom

    In the text, Billingsley lists four major structures of African American Family Types: 1. Married Couple with no children, 2. Married Couple with children, 3. Unmarried mother with children, and 4. Unmarried father with children.  The majority of those reported by the respondents fall into categories 2 and 3, with almost half falling into category 3. In Table I.3 on page 33-34 of the text, the author breaks down the family configurations into sub-types which he labels “Modified Nuclear” with alternative headship: 1. Natural Parent (Divorced, separated, widowed, never married parent) 2. Surrogate parent (lone adult raising grandchildren, nieces, nephews, foster children), 3. Natural Surrogate parent (Divorced, separated, widowed, never-married parents raising his/her own children, their cousins, or foster children). These conglomerates support the reports that African American Family patterns in less advantaged situations, have shifted from predominantly nuclear family types to those that form bonds based mainly on kinship through blood lines. Driven by the external pressures threatening the their stability, these families form mini-communities of mutual support, binding together to share resources and fill needs as social and  economic conditions work against their favor.    The values underlying these types of bonds seem to be lacking where delinquent behavior factors heavily in the equation. While 9 respondents reported no sense of important family values, 6 reported values such as mutual respect, honesty, trust and loyalty as being important. In cases where values are not identified, modeled, expected or instilled, risk for maladjusted behavior appears more prevalent. One wonders where is the breakdown of values transmission? Is it in lack of communication and cohesion and shared sense of identity between members? Is it lack of accountability or emotional/psychological disinvestment in functional familial roles? Does this lead to detachment and disenfranchisement from behaviors that otherwise belie the tendency to positive, cooperative social adjustment? 

Q4    What are your important family values?

R1    0        0
R2    1        mutual respect
R3    0        don't know
R4    2        respect, protect each other
R5    1        we just take care of ourselves
R6    1        honesty
R7    1        doing things for each other
R8    0        don't know
R9    0        don't know
R10    2        trust, loyalty
R11    0        don't know
R12    0        no answer
R13    0        none
R14    0        no response
R15    0        don't know

    In spite of a majority lack of shared values, the respondents report that work ethic is a strong component of the families in question. Each of the respondents reported an expectation placed upon them by their family guardians (though in some cases they were ignored, which speaks more about the character of the individual delinquent behavior).

Q3    What are the expectations they have of you?

R1    3        Sweeping, dishes, trash, clean room
R2    3        trash, clean room, home for dinner
R3    2        go to school, find a job
R4    3        house rules, chores, curfew, cleaning
R5    0        none
R6    3        chores; court requires curfew, but mom does not enforce it
R7    3        clean room, dishes, trash
R8    2        chores, curfew
R9    1        chores
R10    3        curfew, trash, help w/ younger kids
R11    2        curfew( ignores it), chores
R12    2        curfew, chores
R13    1        used to do chores before living in shelter           
R14    3        curfew, dishes, clean room
R15    1        chores

    Regarding the parental work ethic (which would be the strongest indicator of a positive influential modeling) all heads of household were employed except two. In cases of two parent households, both were employed, which again, displays the strong work ethic (even though additionally there were reported cases of access to welfare programs to supplement basic needs).
 

Q13     Who employed in the home?

R1    1        mom
R2    2        mom, dad
R3    1        dad
R4    2        mom, stepdad
R5    2        mom, stepfather
R6    2        mom
R7    1        mom
R8    2        mom, stepfather
R9    1        aunt
R10  1        stepfather
R11            no one
R13  2        mom, brother
R14            no one
R15  2        mom, dad

    Other questions which reflected the hopes and dreams for the future:

Q35     What are your goals for the future?

R1            go home, get into school, get a job
R2            get a job to provide for daughter
R3            just be left alone
R4            earn a diploma; get a job with something creative or artistic
R5            i have other stuff to deal with that's just as important as a diploma like staying off drugs
R6            food service work, finish school
R7            army
R8            get a degree, work in a trade
R9            get out
R10            get a job, help mom, his girlfriend and child
R11            graduate, get a job, join the military
R12            graduate, get a job
R13            go home
R14            graduate, get a job
R15            go home

Questions about impediments to realizing their dreams for the future:

Q36    Barriers from realizing goals?

R1            transportation, clothes
R2            clothing, interview skills, transportation
R3            being locked up; family don't like my decisions
R4            money
R5            none
R6            being in placement, eager to get out
R7            being locked up; money for school
R8            none
R9            none
R10            none
R11            probation
R12            being locked up, no family w/ money or education that can help
R13            none
R14            none
R15            probation

    In conclusion, this experiment was an attempt to show the relationship between delinquency and crime. The risk factors influencing the likelihood for a young black male adolescent’s future incarceration have obvious implications. The risk of incarceration grows among those suffering least access to education, wages and opportunity. Low education begets low wages, which begets low opportunity and this leads to the inability to fund the cost of basic living standards. As a result these men turn to crime, make contact with the underground economy, which eventually takes over their lives. Without a strong educational foundation as the basis for building upon positive opportunities, it is likely that the allure of the alternative offered in the underground economy will set up the individual for habitual involvement in socially unacceptable pursuits. The charge of the young black male is to face the fight that lies ahead of him: to rise up, confront and rebel against the institutional barriers that threaten ultimately to reduce or eliminate his ability to reach his fullest human potential.