In 1973, Lt. Cmdr. John McCain published a first-person account of his more than five years in captivity in Vietnam.
"As far as this business of solitary confinement goes," McCain wrote in U.S. News & World Report, "the most important thing for survival is communication with someone, even if it's only a wave or a wink, a tap on the wall, or to have a guy put his thumb up. It makes all the difference."
Sgt. Bowe Bergdahl is the longest-held captive to be returned to the United States since Vietnam. Last week, the 28-year-old Idahoan arrived at the Brooke Army Medical Center in Fort Sam Houston, Texas, where he is being eased back into life outside of captivity.
Like now-Sen. McCain, Bergdahl was held for more than five years. But unlike the Vietnam prisoners of war, Bergdahl had no contact with fellow American soldiers. That's one of the reasons experts who have worked with former captives say they expect Bergdahl's recovery to be especially difficult.
"He has a very long road ahead of him to reintegration and recovery," said Brian Engdahl, a psychology professor at the University of Minnesota who specializes in PTSD and veterans research and has surveyed former POWs about the long-term effects of captivity on mental health. "If it is true that he was held in severe solitary-confinement conditions, the world—even the controlled environment he is now in—will be very overwhelming."
As the psychologists and U.S. Army South personnel tasked with Bergdahl's reintegration learn more about how he survived in the hands of the Taliban-affiliated Haqqani Network, they will also uncover how much of the last five years he missed. In that time, smartphones and National Security Agency surveillance found their way into the lives of millions of Americans, developments that may not be part of Bergdahl's knowledge.
That includes the negative public reaction to the circumstances of his release. The Army announced earlier this week that they are starting to expose Bergdahl to media reports about the deal that let five dangerous detainees out of Guantanamo Bay and prompted a congressional outcry over national security.
Lasting negative public opinion could hamper Bergdahl's recovery, based on the experiences of the POWs from past wars. Operation Homecoming, the organized welcoming and repatriation of 566 Vietnam POWs in 1973, marked a moment when the veterans were treated as heroes—a deliberate attempt by the Defense Department to prevent a repeat of the aftermath of the Korean War, Engdahl said. Two decades earlier, the more than 4,400 Korean War POWs who returned to the U.S. were treated with suspicion of brainwashing by the enemy and many felt shame and humiliation for having failed a mission and been captured.
"How people are welcomed back is a really important piece of how well they're doing, which is one of the concerns for Bergdahl," said Elspeth Cameron Ritchie, a former Army psychiatrist who worked on mental health issues in the Army Surgeon General's Office, and currently serves as the chief clinical officer of the District of Columbia's Department of Mental Health. "So far, it doesn't look good."
By the early 1970s, the military had a system in place to monitor the psychological trauma of captivity, and the Robert E. Mitchell Center for Repatriated POW Studies located in Pensacola, Fla., holds the only existing longitudinal study of the long-term medical and psychological effects of posttraumatic stress on POWs from the Vietnam, Gulf, and Iraq Wars.
The differences among the groups of POWs from America's various wars is stark: Approximately 30 percent of the Vietnam War repatriates have been diagnosed with PTSD, according to the Mitchell Center's Executive Director Jeffrey Moore, while Engdahl's research found lifetime prevalence of PTSD among Korean War POWs to be 67 percent.
Because the Vietnam POWs had been held for much longer than those of Korea and WWII—the longest Vietnam POW remained captive for nearly nine years—Moore said the military and their families were told to expect them to return with severe psychiatric illnesses.
"That was totally wrong," he said. "The vast majority of returning POWs were not only physically and psychiatrically healthy, but remained on active duty and returned to their pre-captivity jobs as aviators." Moore estimates that 80 to 85 percent of Vietnam POWs returned to active flight status.
Public reception and conditions of confinement aren't the only factors that play into how well the returned captives returned to "normal" life; rank in the military also matters, Moore says. "The older the officer or enlisted person, the more likely they have many years of service prior to captivity and the more likely that their identity includes serving until retirement," he wrote in an email.
Engdahl said the characteristics of the Vietnam POWs stand out and are related to the way they recovered. And this has a bearing on Bergdahl. "As a group, [Vietnam POWs] were college-educated, they were older, they were officers, they were married," Engdahl said. "They were a more unusual group compared to other POWs, and certainly unusual compared to Bergdahl. He signed up for only a few years. "
Certainly, it is possible Bergdahl would return to service. "The goal of reintegration is to return a soldier to duty," Col. Bradley Poppen said last week at a press conference after Bergdahl landed on U.S. soil. Poppen is a psychologist trained in the Survival, Evasion, Resistance, and Escape military program and is assigned to help Bergdahl reintegrate.
But because the circumstances of Bergdahl's disappearance are under investigation by the Army, Bergdahl might not have that chance. If he is found to be a deserter, Bergdahl could be dishonorably discharged from the military, if not punished for a crime.
Even if he is granted the option of renewing his contract with the Army, Ritchie says it's unlikely that he would.
"For reintegration, the successful experience as a civilian is also a goal," she said. "I think it would be very hard for him to go back to duty with other soldiers who were angry that soldiers died searching for him."