Debriefing the Ghosts

Report of Dr. Phan Thi Lien, Chief Psychiatric Officer, Ward 7, Cong Hoa General Hospital, Saigon. Prepared for the Medical Directorate, Army of the Republic of Vietnam, at the request of Colonel Duc Thanh Binh, December 1972.

I have been asked to account for the treatment outcomes on my ward. I will do so. But a report that accounts only for outcomes and not for the conditions that produced them is a lie told in the language of tables and percentages, and I have been trained — by the French, no less, whose language I still dream in and whose diagnostic categories I still apply to Vietnamese minds the way one applies a stencil cut for a different shape — I have been trained to be precise. So I will be precise.

Ward 7 holds thirty-two beds. This morning, twenty-nine are occupied. Of the twenty-nine men on my ward, eleven have been classified as suffering from what the French call névrose de guerre and the Americans call combat fatigue and what I, in my own notes, the ones I do not submit, call the body’s refusal to cooperate with its own destruction. The remaining eighteen present with conditions ranging from acute anxiety states to what Private Vo Dinh Khanh, bed fourteen, describes simply as “my head has left me.” He means this literally. He believes his head is elsewhere — in the village where his unit conducted operations in Quang Tri Province in September — and that what sits on his shoulders now is a replacement, installed by someone he cannot identify, which does not fit properly and through which sounds arrive muffled, as if underwater.

I have treated Private Khanh for eleven weeks. The treatment protocol, adapted from Salmon’s principles of proximity, immediacy, and expectancy, is designed to return him to his unit within thirty days. We are now on week eleven. He still believes his head is in Quang Tri.

This is what I mean by precision. The protocol has a goal: return the man to combat. The man has a condition: he cannot inhabit his own body. The protocol does not ask why the man’s body has become uninhabitable. It asks only how quickly we can make him forget that it is.

I should say something about my qualifications, since the Colonel’s request implies — politely, in the Vietnamese manner, which means the politeness is the blade — that my methods are under review.

I trained at the Faculté de Médecine de Saigon under Dr. Henri Baruk’s curriculum, which was itself imported from Paris in 1948, three years before I was born, and which arrived in Indochina already obsolete but carrying the authority of the metropole, which is a kind of obsolescence that never expires. I completed my residency at Cho Ray Hospital under Dr. Nguyen Van Hoai, who had studied under Baruk’s student and who taught me that the French psychiatric tradition, whatever its limitations, at least took the interior life seriously — unlike the American model, which had by then begun arriving in our hospitals the way American everything arrived: abundantly, confidently, and with instructions printed in a language most of the staff could not read.

The Americans brought Thorazine in boxes labeled for a body weight twenty kilograms heavier than the average Vietnamese soldier’s. I adjusted the dosages myself, working from a conversion chart I drew up on the back of a supply request form, because the literature assumed a patient who weighed what Americans weigh, ate what Americans eat, and metabolized grief at the rate Americans consider standard. This is a small detail. It is also the whole story in miniature — the wrong frame, applied to the wrong body, producing results that are then measured against the wrong baseline, and the discrepancy recorded as a deficiency in the patient rather than the method.

My father would have found this amusing. But my father is not available for comment, having died in 1954 at Dien Bien Phu, on the other side.

I have not included this fact in previous reports. I include it now because the Colonel has asked me to account for outcomes, and an honest accounting requires a complete inventory, and I am part of the inventory. The daughter of a Viet Minh soldier, trained in French colonial psychiatry, treating soldiers of the Republic for wounds inflicted by the army her father died serving. The Americans have a phrase: conflict of interest. I have always appreciated its compression. As if a conflict could be a matter of interest, like a bank rate, something to be declared and managed rather than something that runs through you like a river through limestone, hollowing you from the inside while the surface remains smooth.

The men on my ward do not know about my father. They know only that I am Dr. Phan, that I am small and quiet and that I listen to them with an attention they find, at first, unsettling, since most of them have never been listened to by anyone with authority. A Vietnamese woman with authority is a category error in their experience, and they manage it in various ways — some by treating me as a mother, some by treating me as a nun, some by refusing to speak at all, which I record in their files as “resistance” because the protocol requires a clinical term for the simple human act of declining to perform your suffering for a stranger.

Corporal Tran Minh Duc, bed six, is one of the silent ones. He was transferred from the 21st Division after the counteroffensive at An Loc, where his unit held a position for nine days under continuous shelling. He arrived on my ward in October with both eardrums ruptured, a condition that has healed, and a mutism that has not. He can hear. The audiologist has confirmed it. He can speak — the nurses have heard him talking in his sleep, full sentences, in a voice they describe as calm and conversational, as if he were ordering pho from a street vendor. But when awake, when addressed, when examined, he produces nothing.

I have sat with Corporal Tran for forty-minute sessions, three times a week, for eight weeks. The protocol says to begin with rapport-building questions — name, hometown, family, unit. The protocol was written by men who assumed the patient wanted to be known. Corporal Tran does not want to be known. He wants to be absent, and his silence is the closest he can come to absence while still occupying a bed.

On the ninth week, during what I had recorded in advance as a routine session, he spoke.

He said: “You are also hiding.”

I did not respond. This is what I was trained to do — the analyst’s silence, the held mirror. But his eyes were on me with a directness that the protocol does not prepare you for, and I understood that he was not transferring, not projecting, not doing any of the things the textbook says patients do when they make observations about their doctors. He was simply seeing me. The way a man who has spent nine days watching a treeline for movement learns to see what is actually there rather than what should be there.

“I don’t know what you mean,” I said, which was a lie delivered in the clinical voice, which is a particular kind of lie — the kind that sounds like objectivity.

He looked at me for a long time. Then the silence resumed, and I noted in his file: Patient initiated verbal contact. Content: projection re: therapeutic relationship. Recommend continued sessions.

That night I went back to my apartment on Nguyen Du Street — two rooms above a tailor’s shop, the sewing machine audible through the floor until ten each night, a sound I have come to find comforting in the way one finds comforting anything that is regular and purposeful and has nothing to do with war — and I opened a bottle of Ba Muoi Ba beer and I sat on the bed and I thought about what Corporal Tran had said.

You are also hiding.

He was correct. I have been hiding for twenty-one years, since my mother told me, the year after Geneva, that my father had not been a schoolteacher who died of tuberculosis, which was the story I had been raised on, but a cadre of the 312th Division who died in the assault on strongpoint Eliane 2, and that I must never, under any circumstances, tell anyone this, because the Republic was being built on the graves of men like my father, and the daughter of such a man could expect to be built upon as well.

My mother delivered this information the way she delivered all important information: flatly, without sentiment, while doing something else with her hands. She was mending a shirt. She did not look up. The needle kept moving. I was three years old when he died. I do not remember him. I remember only the story of the schoolteacher, which was the first diagnosis I ever received — a story applied to a wound to keep it from being seen.

The American advisor assigned to our hospital is Major David Hurley, who is from a place called Terre Haute, Indiana, which he pronounces without any of the French, so that it sounds like an illness. Major Hurley is a psychiatrist trained at Walter Reed. He believes in pharmacology and rapid return to duty. He brings with him crates of chlorpromazine and literature on “brief reactive psychosis” and a confidence in his diagnostic categories that I recognize as a specifically American form of faith — the belief that if you can name a thing accurately enough, you have mastered it.

Major Hurley and I disagree about Private Khanh.

“The dissociative symptoms should have resolved by now,” Hurley says. We are standing in the corridor outside the ward. It is November. The air smells of antiseptic and jasmine from the tree in the courtyard, a combination I will never be able to separate from this period of my life. “Are you sure you’re not reinforcing the delusion by engaging with it?”

“I am listening to him describe his experience,” I say.

“Right. And by listening, you’re validating a delusional framework. He needs to be oriented to reality.”

I do not say what I am thinking, which is: whose reality? The reality in which a twenty-year-old rice farmer from Long An Province is a soldier in an army funded by Americans, trained by Americans, fighting a war whose strategic logic is determined in Washington and whose tactical logic is determined in Hanoi, neither of which he has ever visited or could find on a map? The reality in which he was sent to a province he had never heard of to kill people who speak his language and who, in a different configuration of history — my father’s configuration — might have been his neighbors? That reality?

Private Khanh’s head is in Quang Tri because Private Khanh’s head is the only thing he was able to leave behind. The rest of him was ordered to return. His delusion is not a failure of reality-testing. It is the most accurate description available to him of what the war has done.

I say none of this to Major Hurley. I say: “I will adjust the protocol.”

This is the language of the institution. Adjust the protocol. It means nothing. It means: I will continue doing what I am doing but will describe it differently in the paperwork. This is a skill the French taught me, though they would not recognize it as French. The Vietnamese have been adjusting protocols since before the French arrived. We do it with such sincerity that the sincerity itself becomes a surface, and what happens beneath the surface is our own.

Three things happened in November that I should record.

The first: Private Khanh, during a session, told me that the head he has now — the replacement head — sometimes receives transmissions from the head he left behind. The transmissions are not words but sensations. Heat. The smell of burning thatch. A pressure behind the eyes that he associates with a specific moment, which he then described. His unit entered a hamlet. They were told it had been cleared. It had not been cleared. There was a woman in one of the houses. She was holding something. It was not a weapon.

He stopped. I waited. He said: “The old head saw what it was. This head does not want to know.”

I wrote in my official notes: Patient reports pseudo-hallucinatory experiences consistent with dissociative processing of traumatic material. Recommend gradual exposure protocol.

I wrote in my own notes, the ones I keep in a locked drawer in my apartment, in a notebook with a blue cover: He has done what I have done. He has divided himself into the one who saw and the one who continues. He has made a border inside his own skull and posted a sentry there, and the sentry’s job is to prevent the two halves from meeting, because if they meet, if the old head and the new head are ever in the same room, he will have to be a single person who did a single thing, and he is not ready for that, and I do not know if the protocol — any protocol, mine or Hurley’s or the one the French brought here like a piece of furniture that does not fit the room — has any right to force that meeting.

The second thing: Corporal Tran spoke again. He said, during a session in which I had been reading aloud from a newspaper — a technique of my own, not in any manual, based on the theory that a man who will not speak may still wish to be spoken to — he said: “My grandfather was Viet Minh.”

I put the newspaper down. I looked at him. He looked at me.

“So was mine,” I did not say. What I said was: “Tell me about him.”

And Corporal Tran told me about his grandfather, who had fought the French at Route Coloniale 4 in 1950, and who had come home after Geneva and lived quietly in a village near Can Tho, and who had never spoken about the war except once, when Tran was twelve and asked him what it was like, and his grandfather said: “It was like being two people. The one who did it, and the one who watched.” And then his grandfather went back to his garden and did not mention it again.

I thought about this for a long time after the session ended. Two people. The one who did it and the one who watched. My father was a man who did it, and the doing killed him, and I became the one who watches — who sits in the chair and holds the clipboard and performs the institutional gaze, the clinical observation, the professional distance that is also a personal hiding place. Corporal Tran’s grandfather survived by dividing. My father did not survive at all. And I have survived by pretending the division does not exist, by living entirely on the watching side, as if the doing side — the Viet Minh cadre’s daughter, the woman with a dead man’s cause silted into her bones — were someone else. Another Dr. Phan. One who exists in a country that does not appear on the Colonel’s maps.

I noted in his file: Patient discussing family history. Positive engagement. Potential therapeutic leverage re: intergenerational military identity.

Therapeutic leverage. The language of the institution, turning a man’s grandfather into a tool for returning him to the war.

The third thing: I received orders that Ward 7 would be inspected in January by a delegation from the Medical Directorate, accompanied by American observers. The purpose was to evaluate our return-to-duty rates, which are, by the standard the protocol demands, poor. Of my twenty-nine patients, I have returned four to their units in the past quarter. The expected rate is twelve.

The Colonel’s letter requesting this report is, I now understand, preparation for that inspection. He wants documentation. He wants numbers that can be read favorably. He wants me to explain, in the language of clinical outcomes, why I am failing to produce soldiers.

What I cannot explain to the Colonel, what the report format does not accommodate, is this: I do not believe the men on my ward are broken. I believe they are responding. The mutism, the dissociation, the night terrors, the paralysis, Private Khanh’s decapitated selfhood — these are not malfunctions. They are the body’s own accounting, its private ledger, its refusal to accept the terms.

But a military hospital does not treat responses. It treats failures. A soldier who cannot fight is a system error. My job is to debug the system and return the unit to operational status. That the unit is a person, that the error is the war — this is not in the protocol.

I think about Rivers at Craiglockhart, in the other war, the British one. I have read the accounts. He saw the same thing I see: men whose symptoms were the sanest thing about them, men who stuttered and shook and went blind not because they were weak but because their bodies had found the only available language for refusal. Rivers cured them. He was gentle and brilliant and he cured them and sent them back, and some of them died, and he knew they would die, and he did it anyway, because the institution’s logic is a current stronger than any individual conscience. I do not judge Rivers. I am Rivers. We are all Rivers, those of us who sit in these chairs across from these men and perform the institutional function of compassion, which is: to make the damage feel heard so that the damaged can be returned to the source of the damage.

The difference is that Rivers worked within his own country’s war. I work within someone else’s. The categories I use are French. The drugs are American. The patients are Vietnamese. The war is — whose? Ours, because we are dying in it. Theirs, because they designed it, on both sides — the Americans drew up the South, the Soviets and Chinese underwrote the North, and we are the medium through which their contest is conducted, the way a canvas is the medium through which paint becomes a picture, except the canvas does not usually have an opinion about the picture, and we do, and our opinions are irrelevant.

My father had an opinion. He expressed it at Dien Bien Phu. It was an opinion about the French, about whether they had the right to design the shape of his country, and he expressed it by climbing into a trench and not coming out. This is the most direct form of psychiatric communication: the body as statement. I have spent my career translating such statements into clinical language, which is to say, neutralizing them. My father spoke with his whole life; I write “acute stress reaction” and prescribe chlorpromazine.

December. Corporal Tran and I have established something I hesitate to call a therapeutic relationship because the word “therapeutic” implies that I am the healer and he is the wound, and I am no longer certain which of us is which.

He talks now. Not freely — the sentences come with gaps between them, silences that have weight, that are not empty but full, the way a rest in music is full of the notes on either side. He talks about An Loc. About the shelling, which went on so long that it stopped being an event and became a condition, the way rain is a condition, or gravity. He talks about the moment the shelling stopped and the silence was worse, because the silence meant they were coming, and the silence lasted — he says — for either thirty seconds or three hours, he cannot tell, because time on the ninth day had become a different substance, thicker, less transparent, and he was moving through it the way you move through water in a dream.

He does not talk about what happened during the assault. He talks around it. He describes the before and the after and leaves a space in the middle that has the shape of the thing he cannot say, the way a mold has the shape of the object that was cast in it.

I do not push him toward that space. The protocol says I should. Hurley says I should. The exposure literature says the patient must confront the traumatic memory directly, must narrate it, must bring it into the light where it can be examined and defused. But I have been in my own version of that space for twenty-one years — the space where my father is simultaneously a schoolteacher and a soldier, where I am simultaneously a loyal citizen of the Republic and the daughter of a man who died fighting to prevent the Republic from existing — and I know that some spaces do not survive being narrated. Some things can only be carried in silence, and the silence is not pathology. The silence is architecture. It is the structure that holds the rest of the life in place.

“You don’t ask me what happened,” he says, one afternoon in December, the light coming through the ward windows in the flat white glare that Saigon produces in the dry season, without warmth, without color, like the light in a photograph.

“No.”

“The American doctor would ask.”

“Yes.”

“Why don’t you?”

I think for a moment. I think about what Rivers would do, about what Baruk would say, about what the protocol demands. And then I say something that is not in any protocol, that would be grounds for dismissal if the Colonel heard it, that is the truest thing I have said in a clinical setting in twenty-one years of practice.

“Because I know what it costs to answer.”

He looks at me. The look lasts a long time. Then he nods, once, and the session ends, and I write in his file: Continued rapport-building. Patient progressing toward engagement with core material. Which is a lie and a truth at the same time, which is the only kind of sentence this war allows.

There is a sergeant on the ward whom I have not yet mentioned. Sergeant Ly Quoc Bao, bed twenty-two. He is older than most of the men — thirty-eight, a career soldier, with the kind of face that looks as if it has been carved by someone who ran out of patience and left the features approximate. He was admitted for what his commanding officer described as “episodes of inappropriate laughter.” In the field, during operations, Sergeant Ly would begin laughing — not hysterical laughter, the nurses reported, but a measured, deliberate sound, almost social, as if someone had told a moderately funny joke. He laughed during firefights. He laughed during briefings. He laughed during a memorial service for three men in his platoon killed by a mine on Route 13.

I asked him about the laughter. He said: “I am not laughing.”

“Your commanding officer reported —”

“I know what he reported. But that is not laughter. That is the sound my body makes when it understands something my mind refuses to understand.”

“What does it understand?”

He looked at me with the patience of a man explaining something elementary. “That none of this is real, Doctor. Not the war, not the army, not the Republic, not the Americans, not the Communists. It is a play. We are all actors. Some of us have noticed this and some have not, and the ones who have noticed — the ones whose bodies make the sound — we are not sick. We are the audience.”

I wrote in his file: Derealization symptoms. Possible dissociative disorder NOS. No evidence of psychotic process — affect appropriate to stated beliefs, insight partial.

But I think about what he said. I think about it often. The play. The audience. The sound the body makes when it understands. My father, climbing into his trench at Dien Bien Phu — was he an actor or the audience? Was his death a line in the script or the moment he stopped performing?

I do not laugh. My body makes a different sound when it understands. It makes silence. It has been making silence for twenty-one years.

I should explain what will happen to this report. I will submit it. The Colonel will read it and find it insufficient. He will note the low return-to-duty rate and the absence of actionable recommendations. He will recommend that Ward 7 be restructured under Major Hurley’s supervision, with a focus on pharmacological intervention and rapid processing. The American observers will concur, because concurrence is what observers are for. I will be reassigned, perhaps to an outpatient clinic, perhaps to a province hospital, perhaps out of the military medical service altogether.

And the men on my ward will be treated by someone who believes the protocol, who administers the chlorpromazine on schedule, who conducts the exposure sessions with professional detachment, who returns eight or ten or twelve men per quarter to their units, where some of them will function adequately and some will not and some will die, and the numbers will improve, and the numbers are what the institution requires, because the institution does not treat people. It processes material.

Private Khanh will be told that his head is not in Quang Tri. Corporal Tran will be told to speak. Sergeant Ly will be told that the war is real and his laughter is a symptom. They will comply or they will not, and either way the protocol will have been followed, and the protocol’s conscience is clear, because protocols do not have consciences. Only people have consciences, and people can be replaced.

This report was requested in the language of outcomes. Here are the outcomes.

Of the thirty-two men who have occupied beds on Ward 7 during my tenure, I have returned eleven to active duty. Of those eleven, I have been able to track seven. Three are still serving. Two were wounded in subsequent actions. One is dead. One has deserted. I do not know what happened to the other four, which is itself an outcome — the outcome of a system that tracks the movement of bodies but not the continuation of persons.

Of the twenty-one men I did not return to duty, six were discharged for medical reasons unrelated to their psychiatric condition. Eight were transferred to other facilities. Four remained on my ward at the time of this report. Three were transferred at their families’ request to civilian care.

These are the numbers. They do not contain the men. They do not contain Private Khanh’s belief that his head is in Quang Tri, or Corporal Tran’s nine-day silence, or the sound Sergeant Ly’s body makes when it understands, or the locked drawer in my apartment on Nguyen Du Street where I keep a blue notebook full of things the protocol does not have categories for.

They do not contain my father, whose name was Phan Van Tho, whom I never knew, who died in a trench at Dien Bien Phu fighting for a country that was not yet the country I grew up in, and whose death made me possible — the daughter raised in the South, educated in the colonizer’s science, employed by the army his army became — in the way that a hole in the ground makes a foundation possible. You build on what is missing. You live in the structure raised over the absence.

The Colonel has asked me to account for outcomes. I have done so. I submit this report with the understanding that it will be found insufficient, which is the most accurate outcome of all.

Addendum, written in the blue notebook, not for the Colonel, not for the file:

After I submitted the report, I went back to the ward. It was evening. The light was the color of weak tea. Most of the men were sleeping or pretending to sleep, which on a psychiatric ward amounts to the same thing — a performance of normalcy for an audience of one, which is themselves.

Corporal Tran was awake. He was sitting on the edge of his bed looking at his hands the way men do when they are trying to recognize something they once knew.

I sat down next to him. Not across from him, in the doctor’s chair, but next to him, on the bed, which is a violation of protocol so fundamental that I note it here without embarrassment, because the protocol and I parted ways somewhere around the fourth page of the Colonel’s report.

He said: “What will happen to us?”

I said: “I don’t know.”

He said: “That is the first true thing a doctor has told me.”

We sat for a while. The sewing machine downstairs in the tailor’s shop was not running because it was not my apartment, it was the hospital, but I could hear it anyway — the ghost of a sound from another part of my life leaking through the walls of this one, the way my father leaks through the walls of the schoolteacher story, the way the old head leaks through Private Khanh’s replacement, the way the war leaks through everything in this country, through every wall and floor and protocol and report, because the war is not an event. It is the medium. We are all conducting it, and it is conducting us, and the only honest diagnosis is the one no one will write: that the pathology is not in the patient. It is in the situation. And the situation is not treatable. It is only survivable, for a while, by those of us who have learned to be two people — the one who does it, and the one who watches.

Corporal Tran’s grandfather was right. My father knew it too, I think, in his trench. And I know it here, in mine, which has a desk and a locked drawer and a white coat instead of mud and a rifle, but which is a trench nonetheless — a position held not because it can be won but because the alternative to holding it is to stop being the person who holds it, and I do not know who I would be then.

I do not know who any of us would be. That is the diagnosis. I file it here, in the blue notebook, in the locked drawer, where no protocol will find it, where no Colonel will read it, where it will sit alongside everything else this war has produced that does not fit the form — the sounds that are not laughter, the silences that are not symptoms, the heads left behind in provinces, the fathers buried in the wrong country’s memory — all of it, waiting for a framework that has not yet been invented, in a language no one has yet agreed to speak.