"We've kicked Vietnam syndrome!" exulted President Bush in 1991, referring to American malaise after the disaster of Vietnam. But although most of its symptoms emerged later, the Persian Gulf conflict clearly marked the beginning of an unexplained illness that has been named Gulf War syndrome. In the summer of 1991, Brian Martin returned from Iraq to his family in Niles, Michigan. He was happy to be home but had a mysterious rash that wouldn't go away. During the next months other symptoms followed--memory lapses, mood swings, and finally debilitating fatigue. He can't work and gets some disability pay from the VA. But even worse symptoms have afflicted Brian's family. His son Deven, conceived shortly after Brian's return, was born with acute respiratory problems and an umbilical cord five feet long. His twenty-five-year-old wife, Kim, has suffered from seemingly unrelated and unconfirmed complaints--rashes, headaches, breast lumps, ovarian cysts, a thinning skull, and unexplained cervical infections. Now the Martins no longer have sex; after intercourse, Kim experiences cramps and a burning sensation: when her husband's semen touches her skin, she told Redbook, it feels "like it was on fire."1 Doctors have been unable to find organic causes for any of the Martin's problems.

In Barrington, Illinois, the Albuck family is also suffering. Gulf War veteran Troy has fatigue, muscle soreness, swollen joints, and headaches, diarrhea, and bleeding gums. His wife, Kelli has hearing problems, migraines, and attacks of pelvic inflammatory disease. She reports that her husband's semen is a toxic substance that "causes sores--blisters which actually open and bleed." Worst of all, their son Alex was born prematurely in 1993 with a rare blood infection and now has cerebral palsy. When he was born, he had a rash that looked like the ones Troy and Kelli have had. Journalist David France declares that "doctors have been unable to explain their cause, give a diagnosis, or prescribe a remedy."2

In Yorkshire, England, Robert Lake's marriage has broken up since he returned from the Persian Gulf, plagued by headaches, vomiting, and diarrhea. Lake had become an army apprentice at sixteen and trained in Cyprus and Germany, where he moved at nineteen. Serving as a radar technician in the Gulf, he was shocked and frightened. On return, he began to have violent mood swings and nightmares of running away from an enemy; he made two suicide attempts and spent two months in psychiatric hospitals, where he was treated for PTSD. He continued to have angry outbursts, his German wife left him, and the army discharged him in 1993. Lake has lost about seventy pounds and has been diagnosed with anorexia nervosa. But he believes that his symptoms come from anthrax inoculations and anti nerve gas tablets he took in the Gulf. "I am angry and disappointed," he told The Guardian, "that the MOD [Ministry of Defense] are so pig ignorant and uncaring."3

The Martins, the Albucks, and Robert Lake are among the thousands of American and British victims of what is called Gulf War syndrome (GWS), Saudi flu, or desert fever. Of the 697,000 U.S. troops who served in the Gulf, 60,000 have reported ailments from memory loss to cancer. The numbers in England are much smaller: 567 veterans, out of 45,000 British personnel, are seeking compensation or disability payments. Veterans' complaints include chronic fatigue, diarrhea, aches and pains, headaches, hair loss, bleeding gums, irritability, insomnia, muscle spasms, and night sweats. Two veterans in Mississippi have claimed to be shrinking.4 Among physicians, politicians, journalists, and veterans who believe that Gulf War syndrome is a new and unique illness, ideas about its cause vary. Many believe that it is contagious and can be passed through sex, sweat, or the air.

Like CFS patients, Gulf War veterans have organized self-help networks. In 1994 David France reported in Redbook that "many vets rely on an informal word-of-mouth network to track the illness, tally developments, or find solace."5 Veterans and their families who live on military bases trade stories, and electronic networks of Gulf War vets are humming; the Internet has hugely expanded opportunities to communicate. Most veterans and their families react angrily to the idea that they are suffering from post-traumatic stress disorder. Willie Hicks, a black veteran from Alabama, told Esquire journalist Gregory Jaynes, "Shit, I don't sleep more than two, three hours a day. Anxiety.... Couldn't get along with nobody.... Couldn't even get out the house.... Post-traumatic stress, my black ass."6 Carole Hill, an English nurse who began to feel tired six months after her husband returned to Cheshire from the Gulf, insists: "This can't be psychological. I've spoken to too many veterans whose families are suffering similar symptoms."7

GWS patients in England and the U.S. are convinced that the cause of their medical problems lies in their exposure to chemicals and drugs in the Gulf, and that their governments are conspiring to deprive them of health benefits and disability pay. Hicks says angrily, "Some of us bleed from the penis. Bleed all over the sheets. Government won't even pay for the sheets."8 "We believe there's a cover-up," British-born Texan Vic Silvester tells The Guardian 9."I was a volunteer, so I have to take whatever I get," one American veteran says. "But my boy and my wife? They did not volunteer, they did not take my oath. They've been drafted against their will and they've got wounds from battle."10 A group of sick wives in Texas has started its own secret research initiative--"secret," according to one of them, "because they fear the military might try to block their study for reasons she can only guess at."11

In fact, American government reactions to Gulf War syndrome have been concerned and sympathetic. No elected politician wants to risk his constituents' anger. The Clinton administration, mindful of alienation over Vietnam and the Agent Orange fiasco, has moved very carefully. President Clinton authorized a scientific advisory panel to investigate the symptoms. Hillary Rodham Clinton has come out as a "friend of Gulf War syndrome sufferers." At the opening session of the Presidential Committee meeting, she said, "Just as we relied on our troops when they were sent to war, we must assure them that they can rely on us now."12 Politicians agree that Persian Gulf veterans deserve respect, attention, and full support, and no decent citizen could object to the research efforts and investigations funded by the government. Since 1994, the government has authorized disability payments for veterans with GWS.

The respectful and cautious responses of the U.S. government, however, have reinforced the suspicion that Gulf War syndrome is a unique disease and fed anxieties and conspiracy rumors about it. Dissenting views have been silenced; when Dr. Edward Young, chief of staff at the Houston VA Medical Center, announced, "There's been mass hallucinations. There's been mass post-traumatic stress disorder" and attributed some of the epidemic to frustration and anger, he was suspended by his boss, Jesse Brown, secretary of the Department of Veterans'Affairs.13 But more skeptical responses of the British Defense Ministry have not quelled protests from MPS or veterans either.

The extraordinary conditions of the Gulf War--and Iraq's admission that they had biological weapons they didn't use have added to suspicions that GWS is caused by a toxic agent. These concerns and questions reappeared when the Pentagon announced in June 1996 that a weapons storage area exploded by American troops contained toxic gases. But there is no clinical evidence that GWS soldiers were exposed to the blast nor that the minute traces of sarin and mustard gas could have caused the enormous variety of symptoms being reported by thousands of veterans five years later. In a "Sixty Minutes" special on August 25, 1996, a group of soldiers from the 37th Engineers Batallion who participated in blowing up an Iraqi arsenal near Kamisayah in March 1991 described their fears at the time of the demolition, and a variety of symptoms since. But CBS did not interview any doctors, specialists in the effects of nerve gas, or Pentagon officials who could support the claim that this chemical exposure could lead to fatigue, gastrointestinal symptoms, and other problems. What has seemed likely all along is that no one incident, toxin, virus, or disease entity is responsible for all the complaints that have been collected under the heading of Gulf War syndrome. 14

Meanwhile doctors are pursuing many other explanations. Dr. Edward Hyman of New Orleans, who believes the syndrome is an arterial infection passed through the air like tuberculosis, has been voted $1.2 million by Congress for research.15 Ross Perot is among those funding a Mayo Clinic project. Dr. Boaz Milner in Allen Park, Michigan, has treated more than three hundred GWS patients. He has suggested at least five possible causes for Gulf War syndrome: radiation poisoning, effects of experimental medicines, environmental contaminants, chemical compounds, and Iraq's biological arsenal. Dr. Eula Bingham, a professor of environmental health at the University of Cincinnati, suspects leishmaniasis, a parasitic infection caused by sand fly bites; but the Armed Forces Epidemiological Board says no. Researchers at Duke have found that the experimental nerve gas pill pyrodostigmine bromide, used in combination with pesticides, caused neurological problems in chickens. When Dr. Stephen C. Joseph, assistant secretary of defense for health affairs, responded that pyrodostigmine stays in the human body for only a few hours, the next suggestion was multiple chemical sensitivity. One entomologist reported that an insect repellent used by 40 percent of the soldiers in the Gulf becomes more toxic when mixed with pyrodostigmine.16 Among the latest stories is that aspartame, an artificial sweetener used in Nutrasweet, is linked to GWS. Now that Hillary Johnson and others are pointing out correspondences with chronic fatigue syndrome, researchers are investigating retroviruses.

Yet government investigations have produced no evidence of an organic syndrome. Dr. Francis Murphy, acting director of the office of environmental medicine and public health at the VA says, "We have found nothing in our investigations that we consider transmissible. We've found no clear-cut evidence that this is being transmitted either casually or sexually."17 A defense department study of more than a thousand ailing veterans indicated that 60 percent had organic ailments with known causes, which were not disproportionate to their random occurrence in the population. Another 25 percent had psychological disturbances, including depression and post-traumatic stress disorder. About 15 percent had unexplained ailments, including headache, memory loss, fatigue, sleep problems, and intestinal and respiratory complaints.18 In January 1995, a panel affiliated with the National Academy of Sciences recommended a fuller and more coordinated study of the problem.19 By April 1996, the results were announced: conducted at a cost of $80 million, the survey of 18,924 veterans found "no single cause or mystery ailment to support suspicions about the existence of a gulf war syndrome."20

In England, results were similar. "I have seen or heard nothing that makes me believe there is a specific syndrome directly attributable to the gulf war," says surgeon-general Tony Revell. A Ministry of Defense study indicated that about 52 percent of those surveyed had minor ailments like asthma. Fourteen percent had more serious disorders, including leukemia and kidney disease. Solicitor Hilary Meredith, whose law firm represents 567 veterans, say nine have died from cancer. Twenty-two percent had post-traumatic stress disorder, and 14 percent had other psychological symptoms, including depression and anxiety.21 In July 1995, the Royal College of Physicians gave its official backing for further investigations, although a preliminary study had concluded that "there was no single cause for the variety of illnesses suffered by the servicemen and women who have been examined."22

Many of these symptoms sound like war neurosis, shell shock, or post-traumatic stress disorder. Despite the rapidity with which PTSD has entered the language, most people do not understand what it means or know about its long history: from the Civil War on, battle fatigue, shell shock, combat neurosis, or PTSD has been observed, studied, and documented, not only in American medicine and psychiatry but around the world.

Since the Gulf War, however, journalists, doctors, government officials, and psychologists have been surprisingly silent about PTSD. Instead, the media have exacerbated fears of Gulf War symptoms. By the summer of 1995, more than two hundred newspaper stories about Gulf War syndrome had appeared in England.23 Even Doonesbury picked up on the controversy, with B.D. complaining to Boopsie about his symptoms and denying that they could be caused by stress: "It doesn't explain why this thing is showing up in family members too! I'm terrified I might end up passing it on to you!"

In the United States, both conservative and liberal journalists have long promoted the idea that Gulf War syndrome is a contagious disease being covered up by the government. In Redbook David France asks why the VA has not authorized semen tests on veterans. In the feminist Women's Review of Books, Laura Flanders writes, "Today many women who served in the Gulf are still in combat, only this time their fight is with the Department of Defense and the Veterans Administration.... After months of struggle and increasing sickness, the tears are now of rage."24 Flanders has also written about GWS for The Nation, where she declares that "fears are growing about just how contagious Gulf War Syndrome may be. Outgoing Senator Donald Riegel conducted a study of 1,200 sick male veterans last year and found that 78 percent of their wives had been affected.... Penny Larrissey, a veteran's wife who told me last year that during intercourse her husband's semen burns, has been in touch with military wives around the country who report not just discomfort but terrible vaginal infections, cysts, blisters and even bleeding sores. Most military family members remain outside the national test samples. And some are invisible altogether. Thanks to the Pentagon's devotion to discrimination, gay men and lesbians whose partners are sick are too scared to ask for help and too intimidated to tell."25

This kind of journalism makes classic history: scare headlines, vague statistics, uncritical descriptions of "studies" and "reports," and the extension of anxieties to gays in the military. Perceptions are reported as facts; undifferentiated and unsubstantiated responses taken seriously as medical evidence. Senator Riegel's staff, for example, surveyed six hundred veterans, 77 percent of whom said that their spouses had some symptoms. On the page opposite Flanders's story, an ad claims, "The most skeptical people in America subscribe to The Nation." One has to wonder why.

Some of the most alarmist, upsetting, and irresponsible journalism has been about birth defects related to GWS. Immediately after the war, there were persistent rumors of birth defects among the families of returning veterans. Laura Flanders notes dramatically that "freakish births are being reported around the country and even internationally."26 In November 1995, Life magazine published a special issue entitled "The Tiny Victims of Desert Storm: Has Our Country Abandoned Them?" On the cover was a color picture of Gulf War veteran Sgt. Paul Hanson and his three-year-old-son Jayce, born with hands and feet attached to stumps. In the story, heart-rending photos of Jayce, "the unofficial poster boy of the Gulf War babies," accompany text full of dire warning and no firm medical or statistical evidence. "During the past year," the story says, "Life has conducted its own inquiry into the plight of these children. We sought to learn whether U.S. policies put them at risk, and whether the nation ought to be doing more for them and their families."

The story describes the anguish of seven families whose children have birth defects, from spinal bifida to mitral heart valve disorder. But reporters Jimmie Briggs and Kenneth Miller do not provide numbers of complaints or controls, although they sneer at "Pentagon bureaucrats" who claim that "at least 3 percent of American babies are born with abnormalities." One activist group, the Association of Birth Defect Children, has gathered data on ailing babies born to 163 of the 970,000 who served in the Gulf War. According to Life, "No one . . . knows how many babies have been born to Gulf vets," and "many still question whether Defense Department scientists are really seeking the hard answers,"27 despite more than thirty studies of Gulf vets by 1995.

Esquire reported in 1994 that "of fifty-five children born to four Guard Units in Mississippi thirty- seven are not normal."28 According to the Mississippi Department of Public Health, however, two babies in these units were born with severe defects and three with minor defects. The VA maintained in May 1994 that the percentage of birth defects in the Mississippi units fell within the normal range--a conclusion that "enraged" one mother, who argued that birth defect statistics were not the point: "Our babies are sick all the time. Why didn't they study our children's immune systems?" Dr. Alan Penman, director of a study by the Centers for Disease Control and Prevention, responded: "We don't believe that there's an excessively high rate of, common illnesses in this group."29

Angry parents like Ammie West, whose daughter Reed was born with a chronic respiratory infection, have condemned the Mississippi study, like other government statistics and responses that offer facts and reassurance, as part of a cover-up. A Pentagon survey of the army's six | largest military installations showed that the rate of spontaneous abortion or miscarriage among veterans' wives was about half the rate of society as a whole. But, says David France, "This result has been denounced by vets as a partial finding at best."30 Parents are understandably anxious and grief-stricken, but we have to question the use" full of scare stories.

Journalists could be more helpful by reminding readers of the atmosphere leading up to the Gulf War and the many forces that contributed to stress and disorientation for participants. In a report of 10,020 Gulf War participants issued in August 1995, the defense department announced, "Physical and psychological stressors were major characteristics of the Persian Gulf. The effect of both acute and chronic stress is a major etiologic consideration when evaluating Persian Gulf veterans. U.S. troops entered a bleak, physically demanding desert environment, where they were crowded into warehouses, storage buildings, and tents with little personal privacy and few amenities. No one knew that coalition forces eventually would win a quick war with relatively few battle casualties. Consequently, most troops did not fight a 'four day war' but spent months isolated in the desert, under constant stress, concerned about their survival and their family's well-being a home, and uncertain about when they would return home."31

In an article for the London Times, Dr. Simon Wessely reminds us just how stressful service in the Persian Gulf was. Troops were afraid that Iraq might use devastating chemical and biological weapons, and "to be ever alert for a silent attack by nerve gas or invisible deadly microbes must have taken a constant toll.... The situation was made worse by the cumbersome protection suits, ill- adapted for the desert heat, that had to be worn as a consequence."32

Testimony from Gulf War veterans with GWS confirms these descriptions. Seventeen percent of Gulf War forces came from National Guard reserve units who had never expected to be on active duty, especially under such ominous conditions. They had heard about the ruthlessness of Saddam Hussein and his unbeatable "elite Republican Guard. "That Saddam's troops proved to be ill-equipped and outnumbered did not undo the months of fearful anticipation. Iraqi Scud attacks on civilian populations intensified fears of a bestial enemy, while propaganda about biological and chemical warfare made every new experience potentially threatening. Soldiers also had to deal with frightening gossip about the preventive medications offered to them.

One Hingham, Massachusetts, soldier, Larry McGinnis, took eight of the anti-nerve gas pills--more than the recommended dose and vomited for several hours. "Here we were," he told a reporter, "driving into Iraq with the 82nd Airborne and me puking over the side into the sand.... I thought I was going to die."33 McGinnis had reason to fear death. In his testimony to the House Subcommittee of the Committee on Veterans'Affairs, he recalled crossing the DMI "with the thought of the body bags and coffins that were being delivered.... But the one thought that kept coming back was Gas Chemical Warfare."34

Women too had profoundly disturbing combat experiences. Sergeant Carol Picou, an army medical officer, drove a hospital truck into Iraq, where she saw charred and smoldering bodies of animals and humans beside the highway. Although Picou had seen burned bodies before, she was frightened: "These bodies were different. They weren't normal." For two weeks Picou and her unit lived near the battlefield, treating injured soldiers and Iraqi civilians from Basra. After she returned from the Gulf, Picou began to suffer from muscle pain, bladder problems, and memory loss. She is convinced that her symptoms were caused not by horror, anxiety, and disgust but by the drug pyrodostigmine.35

Gulf War syndrome is shaping up to be a tragic standoff of men and women suffering from the all-too-real after-effects of war, doctors unable to combat the force of rumor and panic, and a government that feels the need to be supportive of veterans. As Representative Joseph Kennedy told the House Subcommittee, "They come back, were told when they begin to complain of various illnesses that these can be explained through PTSD or through stress. It's one thing for us to hear that. It's another thing, if you've got all these sicknesses . . . and you are being told by a doctor that you go in to see at the VA that, listen, there is nothing really wrong with you--all it is, you know, you've got some psychological problem that is getting in your way--which must be an enormous burden for these individuals to carry around.... Now if in the end the conclusion is that these are illnesses that are explained only through PTSD, that might be the conclusion but it seems to me that we are a long way from drawing that conclusion at the moment."36

That was in the fall of 1992. Years have gone by, but each time the government eliminates a chemical or bacterial cause, suspicion, resistance, and bitterness grows. As Paul Cotton commented in a 1994 report in the Journal of the American Medical Association, the Pentagon's effort to reassure Persian Gulf veterans seems to have "created a candy store for conspiracy buffs. "Among the persistent rumors surrounding GWS are stories of 2,000 concealed deaths among Gulf veterans, mass burials of contaminated Iraqi bodies, the release of a Russian chemical called Novachok, mysterious deaths of camels and goats in the desert, exposure to depleted uranium, the use of soldiers as guinea pigs for unauthorized drugs or vaccines, and widespread burning of soldiers' medical records.37 Meanwhile, thousands of men and women who could be helped by psychotherapy are instead encouraged to pursue endless tests and medical exams; they tend not to see psychotherapists even when their stories make clear that anxiety, fear, and anger are among their symptoms.

Studies have shown that "very substantial proportions of Vietnam veterans with readjustment problems" have never sought help from mental health specialists. Ignorance of therapy, fear of stigma, ideas about masculine self-sufficiency, and lack of information were the main reasons veterans did not seek help. "By far the most frequently reported reason....was the hope or belief that the individual could solve the problem on his own.... Other major reasons ... were feeling as though treatment would not help, not knowing where to get help, distrust of mental health professionals, the respondent's fear of what he might learn from consulting a mental health professional, and the time and cost involved in seeking treatment."38 Education could have changed the way veterans perceived themselves and allowed them to seek care without feeling diminished as men. We do not want the same ignorance and misinformation to persist for Gulf War veterans.

We owe our war veterans a serious debt, but continuing to deny the validity of war neurosis is not the way to pay it. The suffering of Gulf War syndrome is real by any measure, and the symptoms caused by war neurosis are just as painful and incapacitating as those caused by chemicals, parasites, or smoke. But until we can acknowledge that even strong and heroic men and women, fighting in a just cause, can be affected by the conversion of strong emotions into physical symptoms, no double-blind tests or expensive studies will change the likelihood that veterans of even the greatest military victories will continue to become sick.

As charges of sinister conspiracy and high-level government cover-up move in to displace and supplant the medical debate, Gulf War Syndrome becomes an epidemic of suspicion, a plague of paranoia that threatens a greater malaise than even Vietnam.

1. David France, "The Families Who Are Dying for Our Country," Red book, September 1994, 117.

2. Ibid., II6.

3. Melanie McFadyean, "Soldier On," The Guardian Weekend, May 27, 1995, 25 ff.

4. Gregory Jaynes, "Walking Wounded," Esquire, May 1994, 74.

5. France, "Families," 148.

6. Jaynes, "Walking Wounded," 7I.

7. Edward Pilkington, "GulfWar Veterans Fear for their Families," The Guardian, June I2, 1995, 4.

8. Jaynes, "Walking Wounded," 7I.

9. Jonathan Freedland, "Cover-up Alleged as US Denies Gulf War Syndrome Exists," The Guardian, August 3, 1995, 2.

10. France, "Families," 148.

11. Ibid., II6.

12. Quoted in Kenneth Miller, "The Tiny Victims of Desert Storm," Life, November 1995, 62.

13. Jaynes, "Walking Wounded," 73 .

14. See Philip Shenon, "New Report Cited on Chemical Arms Used in Gulf War," New York Times, August 22, I996, AI, BI3.

15. France, "Families," 147.

16. Scott Allen, "Gulf Troops Received Experimental Drug," Boston Sunday Globe, July 3, 1994, I, 16.

. France, "Families," II6.

18. "Report Offers No One Cause for Gulf War Illness," New York Times, December I4, 1994.

19. Philip J. Hilts, "Study on Ailing GulfWar G.I.s Called a Failure," New York Times, January 5, 1995.

20. "Study of 19,000 Finds No 'GulfWar Syndrome,"' New York Times, April 4, 1996, BII.

21. David Fairhall, "GulfWar 'Fever' Rejected by MoD," The Guardian, June 8, 1995.

22. Michael Evans, "GulfWar Syndrome Inquiry Supported," The Times. July 28, 1995, 4.

23. Simon Wessely, "What Is This Mystery Illness Which We Call Gulf War Syndrome?" The Times, July 27, 1995.

24. Laura Flanders, "Bringing the War Home," The Women's Review of Books, II (July 1994): I0

25. Laura Flanders, "A Lingering Sickness," The Nation, January 23, 1995, 96.

26. Ibid., 96.

27. Miller, "Tiny Victims," 46-62 .

28. Jaynes, "Walking Wounded," 75.

29. France, "Families," 147-48.

30. Ibid., 147.

31. "Comprehensive Clinical Evaluation Program (CCEP) for GulfWar Veterans, "Department of Defense, August 1995.

32. Wessely, "What Is This Mystery Illness?"

33. Scott Allen, "GulfTroops," I, I6.

34. Statement to Committee, September 29, I992, Illness of Persian Gulf Veterans, serial no. I02-5I, U.S. Government Printing Office, Washington, D.C., 1993, 84.

35. Flanders, "Bringing the War Home," I0.

36. Joseph P. Kennedy, Monday, September 2I, 1992, in Illness of Persian Gu lf Veterans, 30.

37. Paul Cotton, "Veterans Seeking Answers to Syndrome Suspect They Were Goats in GulfWar, JAMA 27I (I994), 1559, I56I.

38. Richard A. Kulka et al., Trauma and the Vietnam War Generation (New York: Brunner/Mazel, I990), 232.