Combat never ends: the paranoid adaptation to posttraumatic stress.

Among Vietnam veterans with posttraumatic stress disorder, a frequently observed adaptation can be described as "paranoid". This adaptation, reflected in mistrust, proneness to take offense, and restricted affectivity, is integrally related to the meanings that combat experiences have had for these veterans. Both in combat and in their postwar civilian lives, rage and the readiness to counterattack serve to repress fear and vulnerability and to deny guilt. The case of one such veteran is presented to illuminate the relationship between combat and postcombat adaptations and to illustrate how understanding the meanings of combat for the veteran is necessary for successful psychotherapy with such patients.