Having grown up in the shadow of the Holocaust, Susan Hirshfield had a gnawing question she wanted to answer once she got to college: How could a civilian population fail to prevent or protest such an atrocity?
By the time she arrived at UCLA as a Jewish studies major in the early ’70s, she had to grapple with a new calamity: the war in Vietnam. So she took to the streets and joined the anti-war protests.
Although Hirshfield’s family immigrated to the United States from England and Ukraine before the Holocaust, studying its history proved to be “extremely emotional” for her. At the same time, she became acquainted with recently discharged Vietnam War veterans and found her true calling.
“It was being a Jew that led me into the war in Vietnam, and studying post-traumatic stress disorder,” said Hirshfield, now 78 and an Oakland resident.
She described the veterans she interacted with as “a bunch of wonderful people, but very, very damaged. There were physical wounds, but primarily it was the emotional, psychological wounds that they lived with all their lives.”
After receiving a master’s degree in psychology and then a Ph.D., Hirshfield embarked on a 30-year career in clinical psychology working with combat veterans suffering from post-traumatic stress disorder, or PTSD.
She completed a fellowship at Kaiser Hospital’s adult psychiatry department in Santa Rosa and spent four years as a psychotherapist for the Agent Orange Class Assistance Program, where she worked with veterans who suffered from dioxin poisoning. After the program concluded in 1997, Hirshfield launched her private practice in Santa Rosa.
Through her work with Vietnam vets, Hirshfield discovered her clinical skills could also help another population: the blind and visually impaired. Since early in her career, she has worked as an independent-living skills instructor at the Earle Baum Center for the Blind in Santa Rosa.
Hirshfield spoke with J. about the evolution of her work, common misconceptions about PTSD, and how we can create meaning out of our most painful experiences.
This interview has been edited for length and clarity.
J.: There was a point when you were studying for your Ph.D. when you realized everything you studied about PTSD was wrong. What did the scholarships get wrong at the time?
Susan Hirshfield: People didn’t understand what trauma was. And war trauma is such a unique piece. The term “post-traumatic stress disorder” was used to understand the trauma of Vietnam veterans who had no choice but to be there. When they were drafted, the military owned them, could put them in any place they wanted, so they had no agency. It was a unique kind of war. There was absolutely no reason for the United States to go into Vietnam in the first place. World War II veterans, for example, were fighting for a cause, but there was no cause in Vietnam. The United States was not a target.
How accurate are depictions of PTSD episodes in films and TV? Can war flashbacks literally take over a person’s field of vision when their symptoms are triggered?
The war experience changes the brain. Our brains are malleable in general; every experience you have is stored there. Something that may have happened to you 15 or 20 years ago, when you start talking about it, it’s almost like it just happened. With any war there’s the concept of foreground and background. The war transposes those two things, so the war is the foreground, and the life you’re living is the background. It’s just about impossible for people who have never had a trauma to imagine what that could be like.
What inspired you to expand your practice to work with anyone who is dealing with a major life change, whether or not they have PTSD?
It stemmed from the work I’ve been doing for over 30 years now with people who are losing their sight. A friend of mine, a Vietnam veteran with PTSD, connected me to a guy who was born with an eye disease that was very difficult. He was born and raised in Detroit, a failed town. He would not use a cane, he would not admit to his sight loss. He had an attitude when I met him, and I asked, “Why don’t you use a cane?” He said “Could you imagine growing up in Detroit and having to use a cane? I wouldn’t survive a day. I had to be tougher than they were.” So I worked with this man for a while.
I later met with his counselor at the Department of Rehabilitation, and he said, “I’ve been working with him for years now. I have never seen a change in him like in the last six months since you’ve been working with him. What are you doing?” I explained that I was working with his trauma from childhood. I realized that losing one’s sight is a trauma like any other major trauma in a person’s life. The foundation is pretty much the same. How do you deal with the trauma of being terrified that your vision, your primary sense for being out in the world, no longer functions?
Have you thought at all about how the experience of war in Israel might differ from the experiences of American soldiers?
The huge difference is that we don’t live in a country that was being bombed. In Israel, they have been involved in wars, or almost wars, since 1948. You can’t escape the fact that they’re surrounded by countries that have waged war on Israel since its birth. It’s a totally different thing. The people who are fighting in the Israel Defense Forces, they all have a stake in it. It’s personal. That’s probably, weirdly, the beauty of drafting everybody into the military, because they are already living the war in a way.
Of course that does not make Israelis immune to PTSD. Former hostages who were kidnapped into Gaza by Hamas on Oct. 7, 2023, and later released have reported suffering from PTSD symptoms. Yet at the same time, as painful as it is for them to recount their captivity, they also say speaking out helps them persevere. Has this come up in your own practice?
Absolutely. When I was working with combat veterans, I would tell them “you need to talk about what is causing you to be the person you are today, because that’s not the person you want to be. But if you don’t talk, there’s nothing I can do to help you.” I’ve worked with people who were so angry and so traumatized that they couldn’t get words out. One of them told me “I’m afraid that if I tell you what happened, I’ll never come back. I will cease to exist.” I said “I won’t let that happen to you. I am with you, and I’m not going to let that happen.” There was something about the way I communicated with them, and they just started to spill their guts. And it made all the difference in the world. Once they screamed or cried, or whatever it was, they started to come back to the person they were before.
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