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In order to fully answer this question, we need to understand the history of Shinto-Buddhism and their development in relation with the wider Japanese culture. This is a very complex task, so here I will only present the main features of this fascinating process. For a complete overview, please check out my article dedicated to this topic: Beginning of organized religion and foreign contacts in Ancient Japan (The continent of Asia, Shinto-Buddhism, and their contribution to the statecraft of Japan).A common identity, based on some core shared values, can be identified at the foundation of any civilization. In ancient times, religion played a key role in shaping a general conscience. Starting from a wide range of archaic animistic beliefs, Shinto slowly transformed into a state religion, legitimizing the hegemony of the clan leaders and the rule of the first Japanese kings called Okimi. Shinto as we know it today is the result of a complex combination of folklore myths from immemorial times, a constant evolution of collective moral consciousness, economic prosperity closely connected with the division of labor and political intervention, in which the Shinto beliefs were reorganized for personal gains. The second step was the adoption of Mahayana Buddhism in the fifth century AD. Buddhism immediately became a work ethic and a guide for daily interactions between individuals. It also provided the moral support for amazing political, economic and military reforms. In time, Shinto and Buddhism became more and more a syncretic religion, building a strong base for the absolute authority of the Japanese emperor. Furthermore, the debates on the topic of religion provided a vigorous source of inspiration for the first great Japanese works in the fields of statecraft, philosophy, history, literature, architecture, sculpture, painting, music and dancing. Finally, an elementary form of political organization will grow into a state when the neighboring countries acknowledge its existence as a sovereign entity. This is even more true for Japan because the ancient Chinese and Korean states invented a writing system much earlier. At least for the first phases of the Antiquity, all the written sources mentioning the Land of the Rising Sun are foreign. In short, this article wants to answer two important questions: How did the particular spiritual and material elements interact with each other in order to change mentalities, politics and the ancient Japanese society as a whole? and, In what manner did religion and the awareness of otherness contribute to the rise and the consolidation of incipient Japanese statality?The Buddhist faith grew exponentially in the Nara jidai, but Shinto still remained the main religion of Japan. With the exception of a small, highly educated elite, Buddhism was practiced as a complementary spiritual form to the native Shinto. Regardless of how autonomous the Buddhist monasteries became, the clan leaders continued to have the last say in their provinces, as imperial agents sent to control them gradually became more and more corrupt. In their capacity as earthly representatives of the kami, aristocrats sponsored the Buddhist temples from the region that they controlled, conducting Buddhist ceremonies in a Shinto manner. The common folk became more and more enthusiastic about Buddhism, but the vast majority of them ignored the perspective of spiritual enlightenment and salvation, directing their prayers and beliefs towards their everyday problems.Buddhism strengthened social control by imposing a new set of ethics. The architecture of Shinto shrines and religious representations of kamis were also marked by Buddhist art. Before the spread of Buddhism, human-like kami representations did not exist. Some Shinto deities were even worshiped at Buddhist monasteries as protectors of the region, meaning that the archaic tradition of a guardian kami that had powers limited to the space of a local community still continued. Sonoda Koyu underlines the metaphysics behind this peculiar situation. ‘With the rise of increasingly close ties between the native and foreign faiths, doctrines were devised to explain relationships between a protective kami and a protected Buddha. These involved such ideas as a particular kami and Buddha existing as one body and a kami manifesting the essence of Buddha. Therefore the rapid spread of Buddhism during the Nara period was enmeshed - socially, institutionally, and theologically - with native kami worship, making it impossible to understand the development of either without seeing interaction between the two, an interaction commonly referred to as kami-Buddha fusion.’In just a century and a half, Shinto and Buddhism seriously influenced Japanese society, but at the same time, the two religions laid the foundations for the first Japanese state. Matsumae Takashi perfectly describes the situation. ‘The kami were seen as sentient creatures, one step higher than human beings but still possessed by carnal passions and in need of the Buddha’s salvation. On the other hand, kami were regarded as guardians of the Buddhist law. (...) Shinto explained the origins of the Japanese state and sanctified the position and functions of emperors, even though aristocrats below the emperor claimed descent from other kami. Shinto, moreover, linked the court to its own past and to the animistic nature worship that still underlay the whole structure of Japanese society. (...) Shinto was retained in the Japanese belief structure, even though it never developed the metaphysical worldview or system of ethics that characterize world religions. Perhaps this was because of its close connection with Japanese Buddhism, which had enough metaphysics and ethics to serve both.’In terms of trade, technology, arts, literature, military strategy, administrative organization and techniques of good governance, the process of assimilating and borrowing from China and Korea was of utmost importance for the maturing of the Japanese civilization. These mostly secular variables became interwoven with the religious life of the society to such an extent that the phenomenon of ethnogenesis cannot be understood by treating the factors separately. Incipient Shinto was related to other agricultural and animistic religious manifestations from Asia but later evolved as a completely different religion. Clan chieftains justified their sacred authority by taking the role of intermediaries between the people and the gods. Starting as a wide, unpremeditated range of colorful myths, Shinto was partially reshaped to grant the emperor his sacred nature. Buddhism arrived to enhance this absolute authority, offered a prestige that would eventually make the neighboring countries respect and fully recognize Japan as a sovereign entity, and smoothed the road for radical reforms. From a metaphysical perspective, Shinto influenced Buddhism by offering it a more collectivistic trait, while Buddhism came with a complex system of ethics that was completely lacking in the Shinto teleology. The religious syncretism encouraged a remarkable social cohesion which was behind the success of the imperial system, but it also heavily inspired and transformed all the philosophical and artistic forms of expression from the archipelago. Japan managed to adapt the foreign components to its own particular needs. At the end of this procedure, the unique and authentic character of the Country of the Rising Sun emerged.The influence of religion and foreign contacts on the statecraft and national identity of ancient Japan have been analyzed by numerous scholars. Probably the most important ones are Okazaki Takashi, Matsumae Takashi, Sonoda Koyu and Delmer M. Brown. Their contributions have stirred fascinating debates about the circular relationship between material and spiritual elements in history. Did archaic animistic beliefs develop into a national religion thanks to economic prosperity and advanced political strategies, or were economic prosperity and the centralization of an efficient state made possible by the very strong persuasion of pre-existing common spiritual values? Or was the result just a compromise between two complementary phenomena? Do contacts with more developed civilizations encourage the creation of a unique culture or inhibit it because of the imitation?Since the very beginning, the prehistoric culture of the Japanese archipelago was heavily influenced by the continent of Asia. First of all, it’s undeniable that the Incipient Jomon hunter-gatherers arrived in Japan by boat and via land bridges that later disappeared. Second of all, agriculture and iron tools were introduced from China or Korea or both. As in many other ancient societies, the agricultural revolution radically changed the lifestyle of the people. The hunter-gatherers were slowly replaced by a fully sedentary agricultural culture, the Yayoi. In time, the villages grew into tribe federations and from there into small kingdoms. Starting from the Kofun era, Korea was divided into three kingdoms: Koguryo, Silla and Paekche. Those ancient states worked as intermediaries for the cultural, technological and economic transmission from China to Japan. New weapons, military tactics, advanced carpeting techniques and Buddhism were introduced from there. Korea was also the prime source for imports of iron ingots. During the Asuka and Nara periods, Japan grew into a fully fledged civilization based on the model of the Chinese Tang dynasty. Inspired by the economic and cultural successes of the glorious Tang, the Japanese state was centralized under the absolute authority of the emperor, a reign also legitimized by Shinto and Buddhism.Foreign contacts also influenced the ancient Japanese perspective. Although Shinto is now an original and unique religion, in its first phases of development countless myths were borrowed from the Asian continent. Actually, Shinto is a rich source of folk tales and legends, later inspiring works of literature of universal value, simply because the founding pillars were based on varied cultural perspectives, carved by contrasting life experiences. Moreover, the later introduction of Buddhism altered the way Shinto was expressed in arts, added new stories to the traditional narrative, offered ethical perspectives and even adapted some of the animistic rituals, transforming them into more formal and complex ceremonies. Shinto as a state religion was not just a manipulated fraud work of fiction. In order to arrange a compelling force of political legitimization, the ancient scholars tried to choose and be inspired by the most popular and enduring myths from folklore. Even the most enlightened intellectuals of that era were very religious people and their work represented a middle ground between their own mystical beliefs and secular political necessity. By the virtue of this spiritual and material link, Shinto and the ancient Japanese state reached maturity at the same time and were both shaped by each other.While early Shinto progressed spontaneously from the bottom to the top of the pyramid, Buddhism was, first and foremost, used as a political tool. Initially introduced from Korea, the foreign faith was not well received by the native clans whose authority relied on the worship of traditional deities. The numerous aristocrats originating from Korea and China organized themselves around the Soga clan, promoting Buddhism not as a spiritual teaching, but more as a political ideology. Only after the downfall of the Soga family did the Japanese emperors fully recognize Buddhism as a state religion, investing large sums of money in order to consolidate it. Yet, until the late Nara jidai, with a few enlightened exceptions, most of the Japanese understood the Buddhist dogma in a very shallow way, praying for a plentiful harvest or for good health. The reasons behind the adoption of Buddhism were numerous. The Yamato kings wanted to be recognized as the equals of Korean and Chinese sovereigns, and a common religion could have facilitated a better diplomatic dialogue. Trade relations were also facilitated by shared spiritual values. Furthermore, the Japanese started to manifest geopolitical ambitions in the Korean Peninsula and they needed allies to accomplish their high goal. It is not by chance that Paekche, Japan’s most reliable ally, was the one who presented this faith to the Yamato rulers. As China was reunified under the Sui and Tang dynasties, the Japanese elite understood that great political and economic reforms could be faster implemented with the help of a new religion.The main physical features of Japan’s development are less difficult to quantify. From a demographic point of view, the hunter-gatherer society of the incipient Jomon was composed of migrators from Asia, but the Jomon culture flourished in almost complete isolation. The quality of life was significantly improved when they invented and began to trade pottery vessels and when they started to practice plant manipulation, a very early form of agriculture. Looking at the increasing size, complexity and number of the settlements, archaeologists estimated that the population grew from 100,000 to 300,000 inhabitants. Still, the hunter-gatherers were vulnerable to climate changes and their daily existence was very uncertain.Another revolution appeared with the Yayoi migration, when rice agriculture and bronze and iron tools were introduced. Agriculture forced people to settle in villages and work together to a greater extent. Their resources needed to be stockpiled and defended against other villages. The greatest warriors from each locality formed tribes, and by conquering their neighbors, several federations of tribes appeared. Being located closer to Korea and to the iron source, one of the tribes from Northern Kyushu achieved local military supremacy and in the third century AD became the kingdom of the Yamatai mentioned by the Chinese chronicles. Using superior weapons, obtaining more food thanks to better tools and having more resources from the trade with Korea and China, in the course of the next two centuries, the Yamatai advanced toward central Honshu, founding a new capital there. They were named the Yamato kingdom, and after using horse riders tactics inspired from Koguryo, they reached political hegemony in Japan. The rest of the smaller kingdoms either pledged allegiance or were gradually destroyed. In order to honor their victories, the Yamato kings erected huge burial mounds that gave the name of their era: Kofun.With the help of constant trade and advanced agricultural techniques, the Yamato kingdom cultivated vast areas of fertile land. In these auspicious conditions, the population grew and the Yamato kings could collect significant amounts of money from taxes. With larger resources at their disposal, they trained larger and better equipped armies, consolidating their authority by building larger burial mounds. Despite their success, the Korean kingdoms and Chinese empires were becoming even more powerful, posing a potential threat to the Yamato. It became clear that a change was needed, but the political elite was reluctant to radically alter their archaic way of life. Reforms were only moderate. The hesitation was utterly surpassed when Japanese forces were decisively defeated in Korea, and a Silla-Tang coalition could have mounted an invasion at any time. Placed under tremendous external pressure, the king and clan leaders put aside their differences and revolutionized the political, administrative, economic, military and cultural system of the country. At the same time, Shinto-Buddhism emerged as an ideological support.As we have noticed, the previous explanations identified religion, mentalities and ideas in general, as an effect of a material causality. Now we should look at the other side of the argument by saying that none of the great complements mentioned above could have been achieved without the qualitative variables. The Jomon and Yayoi pre-Shinto beliefs had many features from other parts of Asia. The archaeological sites point out, to an overwhelming extent, that the prehistoric population of Japan was religious to its roots. It’s undeniable that the fight for survival motivated the hunter-gatherers to innovate, but another factor was decisive: their inner force. The conviction that everything around them was magical pushed them to express this cosmological feeling in fertility rituals and art. The invention of pottery and other technological advancements were the result of a purpose driven conscience that life was cyclical, and not the other way around. Of course, these things would not have been possible without a friendly natural environment. Although this a necessary cause of the emergence of culture, it is not a sufficient one.The vast majority of scholars conclude that the kingdom of the Yamatai subdued its neighbors more by the force of religious persuasion, and less by military strength. The greatest example was the shaman queen Himiko. Even with the advantage of better weapons from Korea, no tribe was strong enough to subdue all of its neighbors. The ability of the Yamato kingdom to conquer most of Japan solely by military strength is considered even less probable. Technological advancements traveled fast, and after a while, the other kingdoms also adopted new strategies in warfare, and so the conflict reached a stalemate. For example, in her recent article ‘A Hypothesis for Early Kofun Rulership’, Gina Lee Barnes interpreted the apparition of burial mounds as Mother Goddess Worship. To be more precise, the burial mounds helped the Yamato kingdom to become the dominant political force in Japan. According to her, the Yamato kings obtained hegemony following a compromise anchored in religious authority. A coalition of clan chieftains gradually formed around the Yamato sovereigns whose authority and trust were consolidated by a shared early Shinto kami worship and the sacrality of political marriages between the Yamato aristocracy and nobles from other clans. In time, the kingdoms that refused to participate in this system of alliances were defeated by the Yamato coalition. To sum up, the Japanese elite from the Kofun era didn’t manufacture an artificial religion as a form of strengthening an already privileged position, but rather naturally climbed the ladder of power with the help of a spiritual structure that already existed. The making of large-scale projects came as a consequence of the fact that the whole society participated, especially because the population was grounded in archaic traditions that expressed their worldview.The logic of change was not dictated by improving material conditions. William Wayne Farris published a detailed study where he shows that the living standards and demographic and economic growth from the Asuka and Nara periods stagnated and weren’t much better than the ones from the previous era. How then can we explain the success of the reformatory process that we described in this article? A more plausible answer is that thanks to the considerable social ethos created by early Shinto, common traditions and the willingness to accept foreign ideas, the ancient Japanese elite developed an early national conscience. Seeking higher levels of education, they became aware of what was happening on the continent and were inspired by it. A tiny minority represented by leaders like Prince Shotoku had the idea that the shared spiritual framework needed to be supported by stronger pillars. This framework was the real engine of the revolutionary changes from the Classical Antiquity of Japan. Recapitulating, clans that remained loyal expanded together with the Yamato kingdom and their chieftains also erected burial mounds. This was seen by the Yamato sovereigns as a challenge to their reign. The Japanese kings also wished to be treated on equal ground when they talked with their counterparts from Korea and China. The solution for that legitimacy crisis was solved by claiming to be descendants of the most important kami of the Shinto pantheon, and not just any kami. Shinto was a collection of unrelated myths with no ranking system for deities. During the Asuka and Nara jidai, the central government reorganized the traditional faith, transforming the Japanese king into a sacred emperor. The act was officialized in the famous chronicles Kojiki and Nihon Shoki. In parallel, the ruling elite observed that Buddhism had the potential to further sanctify the institution of the emperor, making it stronger in domestic and foreign affairs. Understanding the general background, we can conclude that Buddhism in Japan had at least four stages of development. A initial phase began with the Paekche mission to the Yamato court. Back then Buddhism was embraced only by a small minority, mostly by clans of Korean or Chinese origin. After the crushing defeat at Baekgang, the doctrine was influenced by Silla and so the new religion in Japan was marked by northern and southern Chinese Buddhism. At this point Buddhism spread in all the corners of the country. The third step is represented by the rule of Emperor Tenmu, who integrated Buddhism as an official state religion. Finally, only in the late Nara jidai was the mystical and philosophical system of Buddhism fully comprehended by a broader elite educated according to the Tang model.If we analyze what happened in Nara jidai, it might look like Japan lost its own uniqueness and identity. In reality, the Japanese civilization matured during this process of assimilation. Just as many religious ideas came in different stages from Korea and China, the Japanese art and architecture was inspired from both South Chinese and North Chinese Buddhism, stimulating even more elaborate forms of expression. For instance, the Japanese borrowed the Buddhist iconography and philosophy, but they also adapted the paintings and literary works to the native perspective, highlighting themes like the sorrow of human existence and the fragility of life. As readers might notice in future chapters, the capacity to select and assimilate foreign ideas is one of the most enduring characteristics of the Japanese civilization.Sources used:Delmer M. Brown - The Cambridge History of Japan Volume 1, Ancient Japan, Cambridge University Press, Cambridge, 1993Curtis Andressen - A short history of Japan from Samurai to Sony, Allen and Unwin, Canberra, 2002W. G. Beasley - The Japanese Experience. A short history of Japan, The Orion publishing group, London, 1999Kenneth Henshall - A history of Japan from Stone Age to Superpower, Palgrave Macmillan, New Zealand, 2012Donald Denoon, Mark Hudson, Gavan McCormack, Tessa Morris-Suzuki - Multicultural Japan: Palaeolithic to Postmodern, Cambridge University Press, New York, 2001W. Scott Morton, J. Kenneth Olenik, Charlton Lewis - Japan Its History and Culture: 4th Edition, McGraw-Hill Publishing, New York, 2005Patricia Buckley Ebrey, Anne Walthall, James Palais - East Asia. A Cultural, Social, and Political History, Houghton Mifflin Publishing, New York, 2009George Sansom - A History of Japan to 1334, Charles E. Tuttle Publishing, Tokyo, 1958Karl F. Friday - Japan Emerging: Premodern History to 1850, Westview Press, Colorado, 2012R.H.P. Mason & J.G. Caiger - A History of Japan Revised Edition, Tuttle Publishing, Singapore, 1997P. C. Swann- The Art of Japan From the Jomon to the Tokugawa Period, Greystone Press, New York, 1966Noritake Tsuda - A history of Japanese Art. From Prehistory to the Taisho Period, Tuttle Publishing, Tokyo, 2009Penelope Mason - History of Japanese Art. Second Edition, Pearson Prentice Hall, New Jersey, 2005Donald Keene - Seeds in the Heart. Japanese Literature from Earliest Times to the Late Sixteenth Century, Henry Holt and Company Publishing, New York, 1993John Dougill - Japan’s World Heritage Sites. Unique Culture, Unique Nature, Tuttle Publishing, Tokyo, 2014William Wayne Farris - Japan to 1600: A Social and Economic History, University of Hawaii Press, Honolulu, 2009William Wayne Farris - Sacred Texts and Buried Treasures Issues in the Historical Archaeology of Ancient Japan, University of Hawaii Press, Honolulu, 1998Gina Lee Barnes - China, Korea and Japan The Rise of Civilization in East Asia, Thames and Hudson, New York, 1993Gina Lee Barnes - State formation in Japan. Emergence of a 4th-century ruling elite, Routledge, London, 2007Gina Lee Barnes - A Hypothesis for Early Kofun Rulership, Japan review 27, 2014, pp. 3-29Wontack Hong - Yayoi Wave, Kofun Wave, and Timing: The Formation of the Japanese People and Japanese Language, Korean Studies Vol. 29, 2005, pp. 1-29Mark Hudson - Rice, Bronze, and Chieftains: An Archaeology of Yayoi Ritual, Japanese Journal of Religious Studies, 1992, pp. 139-189Naofumi Kishimoto - Dual Kingship in the Kofun Period as Seen from the Keyhole Tombs, Urban Scope publication, vol. 4, 2013, pp. 1-21Allan G. Grapard - Shrines Registered in Ancient Japanese Law. Shinto or not?, Japanese Journal of Religious Studies, vol. 29, 2002, pp. 209-232Shigefuji Teruyuki - International exchange of Kofun period chieftains of Munakata Region and Okinoshima rituals, Saga University, Faculty of Culture and Education, pp. 89-136Koichi Yokoyama - Early Historic Archaeology in Japan, Nara National Cultural Properties Research Institute, 1976, pp. 27-41Jean-Pascal Bassino and Masanori Takashima - Paying the Price for Spiritual Enlightenment. Tax Pressure and Living Standards in Kofun and Asuka-Nara Japan (ca. 300-794 AD), Economic History Society Conference, University of Warwick, pp. 1-26, 2013Marija Gimbutas - Bronze Age Cultures in Central and Eastern Europe, Mouton & CO. Press, Paris, 1965Marija Gimbutas - The Kurgan Culture and the Indo-Europeanization of Europe. Selected articles from 1952 to 1993, Journal of Indo-European Studies Monograph No. 18, Institute for the Study of Man Washington D. C., 1997Marija Gimbutas and Miriam Robbins Dexter - The Living Goddesses, University of California Press, Berkeley, 2001

Q. Did more Vietnam vets kill themselves after the war?A. The suicide rate among Vietnam veterans in the five years after they were discharged was 34.5 per 100,000. For ex-military personnel who served after that war ended, the equivalent number was just 20.1.Epidemiologists for the Department of Veterans Affairs looked at U.S. veterans who'd returned from Iraq or Afghanistan, and found that 21.9 per 100,000 veterans committed suicide—not much higher than the control group in the previous study.United States military veteran suicide - WikipediaOver 100,000 US Vietnam Vet Suicides To Date! (2007) BestThe Myth And Reality Of Vietnam Vet Suicides (1999)How Many Suicides by Vietnam Vets? (1991)Opinion | Why do so many veterans kill themselves? Here are four theories. (2018)Are more veterans killing themselves today than after Vietnam? (2011)Suicide Rate Spikes in Vietnam Vets Who Won't Seek Help (2012)New VA Study finds 20 veterans commit suicide each day (militarytimes.com) (2016)We Lose Too Many Vietnam Veterans to Suicide: Here’s How You Can Help (2017)29 of the Best Politically Incorrect Vietnam War Slang TermsOver 100,000 US Vietnam Vet Suicides To Date!TOTAL COST TO THE UNITED STATES:$925 BillionEdward Tick sources. United States: Disabled American Veterans; The New York Times; Hell, Healing and Resistance by Daniel Hallock; The Vietnam War: A History in Documents, by Young, Fitzgerald & Grunfel; Webster's New World Dictionary of the Vietnam War. Viet Nam: Army Museum, Ha Noi; Hong Ngoc (Rosy Jade) Humanity Center, Sao Do; Research Center for Gender, Family, and Environment in Development, Ha Noi; Women's Museum, Ha Noi; War Remnants Museum, Ho Chi Minh City.Five Great Books About the Vietnam War for Middle ReadersThe Myth And Reality Of Vietnam Vet Suicides (1999)September 12, 1999 |By Michael Kelley, Special to the Washington PostSince returning from the Vietnam War, 160,000 veterans have committed suicide. Or so reported one reputable veterans' publication.If true, that's nearly three times as many as died in the war itself.I called the editor and asked, “What was your source?''His reporter found a mention of 150,000 suicides in a 1990 book, he explained to me, “and then added 10,000 to reflect the probable increase between 1990 and 1995.''“Great science there,'' I said. “But what would you say if I told you there is absolutely no scientific evidence to support 150,000, or even as many as 20,000, suicides?''At the time, I thought he and other veterans would be overjoyed to learn that the suicide myth was untrue, and that they would share my relief at finding that we are not, after all, such a twisted, tormented and damaged group that 15 or so of us have taken our own lives every single day for the past 30 years. Since then, I have learned that a substantial number of veterans want to believe the myth. Some veterans and veterans organizations have simply enshrined it as fact, institutionalizing the Vietnam veteran as victim, promoting the idea that after losing 58,000 men in the war we had lost that many again - or two or three times that many - who fell into such desperation after coming home that they killed themselves.What became a protracted and stupefying journey into this fantasy world of wholesale veterans suicides began for me with the realization that what I was hearing and reading did not square with my experience.I thought about the infantry unit I served with for 11 months: Delta Company, 1st Battalion of the 502nd Infantry, 101st Airborne Division. About 45 men from that company were killed in action during its four and a half years in Vietnam. If as many vets killed themselves later as died during the war, then 45 of the company's approximately 800 veterans would have committed suicide - or 135, if suicides were three or more times the number of wartime deaths.But in fact, as far as the unit's association can determine, not a single one of those veterans have died by suicide. Struck by the huge discrepancy between the supposed suicide statistics and my knowledge of the veterans community, I went to a local library and spent a few hours thumbing through bibliographies related to veterans' mortality. What I found then and in subsequent research left me reeling.The first surprise was that there already existed a substantial body of scientific literature on the subject. The second surprise was that none of it remotely supported the numbers I saw being published as fact.What on earth brought this plague upon us?The assertion of 58,000 suicides appears to have drawn its first breath in a 1980 manual titled ``Post-Traumatic Stress Disorders of the Vietnam Veteran.'' Published by the Disabled American Veterans, the manual was used widely throughout the Veterans Administration. Its first edition (but none after) noted that ``more Vietnam combat veterans have died since the war by their own hands than were actually killed in the war. That statement was credited to an unpublished paper written in April 1979 by Tom Williams, who also was the editor of the manual. Curiously, his claim came a full eight years before the first comprehensive study of Vietnam veterans' mortality was published.Just where Williams divined his data remains a mystery. (I have made several attempts to find out, but he has never responded to my queries.)From there the suicide story, with numbers ranging up to 200,000, spread to news reports, books, television documentaries and news magazines, and the World Wide Web.Actual mortality studies tell a completely different story.No one knows precisely how many Vietnam veterans have committed suicide. Nor does anyone know how many have died from all causes. We do have information, though, that points to what is possible and what is not.Approximately 3.1 million Americans served in Southeast Asia during the Vietnam War. On average, suicides have accounted for just over 1.1 percent of all U.S. male deaths during the last half of this century. According to research done by the Centers for Disease Control and Prevention (CDC) in the 1980s, suicides were somewhat more elevated for Vietnam veterans than for non-veterans in the same age group during the veterans' first five years after discharge. After five years, though, the differences disappeared.A projection based on the CDC findings shows suicides would represent a shade over 1.2 percent of veterans' deaths from 1967 to 1996. Veterans Administration data indicate that total postwar deaths among Vietnam vets had reached roughly 305,000 by January 1996, so if the percentage suggested by the CDC data is correct, the number of suicides during those 30 years would have been about 3,750.Vietnam War: A Tribute to Our VetsHow Many Suicides by Vietnam Vets? (1991)To the Editor:Although the case Tom Brokaw cites in "Michael Creamer, a Casualty of Two Wars" (Op-Ed, Feb. 18) is tragic, a study of suicides among Vietnam veterans would be in order."Postservice Mortality Among Vietnam Veterans," a Centers for Disease Control study (Journal of the American Medical Association, Feb. 13, 1987, pages 790-95), indicated 1.7 suicides among Vietnam veterans for every one suicide by non-Vietnam veterans for the first five years after discharge. Beyond five years, there were fewer suicides in the Vietnam veterans' group than in the non-Vietnam veterans' group."Proportionate Mortality Study of U.S. Army and U.S. Marine Corps Veterans of the Vietnam War" by Breslan, Kang, Lee and others (Journal of Occupational Medicine, May 1988, pages 412-19) found that suicides were not higher among Vietnam veterans compared with non-Vietnam veterans.Suicides among Vietnam veterans have been said to be 50,000 to 100,000. At any time during the Vietnam conflict, there were 37 million males aged 18 through 35. Of this group approximately 2.6 million served in Vietnam. Of the entire 37 million male population there have been approximately 152,000 suicides.If 50,000 to 100,000 Vietnam veterans committed suicide, that would mean that between one-third and two-thirds of all the suicides in the 37 million population came from the 2.6 million subgroup. There is no factual evidence to support this assertion.The best estimate of suicide among Vietnam veterans, from the Centers for Disease Control in 1988 Congressional testimony, is 9,000.As a Vietnam veteran who regularly visits veterans' hospitals, I fully understand how war wounds the mind as well as the body. However, the problem of veterans of all wars should be considered without sensationalism, and not to make political points. BERNARD A. HEENEY Bayonne, N.J., Feb. 20, 1991The Poetry of the Vietnam WarOpinion | Why do so many veterans kill themselves? Here are four theories.By Thomas E. Ricks April 4Thomas E. Ricks is the author of five books about the U.S. military. He writes “The Long March” column for Task & Purpose, a veteran-oriented website.Why do so many soldiers continue to take their own lives at a higher rate than their civilian counterparts, whether young or old? I’ve spent a lot of time stewing about this over the past few days.It began Monday morning, when I got a note from a vet in a very dark place and contemplating the act. He’d served in Vietnam. His risk of suicide is about 22 percent higher than that of his non-veteran peers, according to a report last year from the Department of Veterans Affairs.That afternoon, I learned that an Army captain who had been featured a while back in my old “Best Defense” column on the Foreign Policy website had gone out in the middle of the night and sat on railroad tracks near Fort Carson, Colo., and a train ran over him; police are investigating the death. He was still in the military but may have been thinking of leaving. People getting out are at the highest risk in the year after they leave — about 1½ to two times as likely to kill themselves as those still on active duty.A friend of his wrote to me, “He was always a high-performing and intelligent guy. He had deployed to Afghanistan with 10th Mountain, then to Kuwait with 4th ID prior to Atlantic Resolve where it looks like you met him. He was on deck to teach Military Science at West Point. He had a wife and daughter. Nothing about his death makes sense. The only indicator I had that he was unhappy was his deep frustrations with the conventional military, the high op tempo for support roles and exercises, and the impact on his family.”Last month, the commander of the Marine 4th Reconnaissance Battalion was found dead in his home. He also had deployed several times to Iraq and Afghanistan.Also recently, I read that a retired major who had served in military intelligence in Iraq had killed himself and his wife.The suicide rate for veterans has gone up 35 percent since 2001, in part because of increases in post-9/11 veterans killing themselves.I know what I am seeing around me is anecdotal. But it just doesn’t feel right to me. What is going on here?Here are four possibilities, specific to the conditions of our recent war:A lost war: My initial thought was that perhaps people are feeling empty and lost as the Middle Eastern war winds down and we don’t have a lot to show for it, besides Iran being more powerful than ever. But a friend who did several tours in Vietnam said he also knew that feeling but didn’t see any rash of suicides in the ’70s among his former comrades.Death by rotation: Another theory is that everyone is born with just so much to give and that repeated deployments drain that reserve, without replenishment. At some point, a person might just decide they can’t do this anymore, that this is too painful and look for the fastest exit.Brain injury: A third theory, related to the extensive use of roadside bombs in the Middle East, suggests that the human brain can, at best, withstand only one or two nearby explosions and cannot heal the deep damage inflicted by repeated blasts.More to come: Or is it that depressed vets are responding to the whiff of another possible war on the horizon, with North Korea?Whether it is one of these, or a combination, or something else, it worries me deeply.A Vietnam War Reading List, Brought to You by the War HallAre more veterans killing themselves today than after Vietnam? (2011)Have military suicides increased?Writing in Slate last week, economist Joseph E. Stiglitz named the rate of suicides among veterans of recent wars as a "social cost of 9/11." He cited stats from a U.S. Department of Veterans Affairs study that looked at the years 2005-07 and found 18 suicides per day among American ex-servicemen. In light of these numbers, and in honor of National Suicide Prevention Week (which began Sunday), the V.A. has posted a toll-free crisis hotline and a link for online chats to its website. Is the suicide rate among veterans any higher now than it has been in the past?It's hard to say because there aren't many reliable data from before the 1960s. But what evidence we have suggests that those who were recently discharged from service in the Vietnam War were more likely to kill themselves than veterans of today's campaigns.A 2004 study by a team led by researchers from the National Center for Environmental Health looked at numbers going back to 1965, and found that the suicide rate among Vietnam veterans in the five years after they were discharged was 34.5 per 100,000. For ex-military personnel who served after that war ended, the equivalent number was just 20.1. A few years later, epidemiologists for the Department of Veterans Affairs looked at U.S. veterans who'd returned from Iraq or Afghanistan, and found that 21.9 per 100,000 veterans committed suicide—not much higher than the control group in the previous study. It's possible that rates will go up in years to come, as more soldiers are discharged after multiple deployments.No one tracked military suicide rates carefully prior to the Vietnam War. Post-traumatic stress disorder wasn't officially recognized by the American Psychiatric Association until 1980, when the psychological fallout from an unpopular war was becoming more visible in the mental-health community.There's evidence that suicides are getting more common among soldiers who remain actively involved in the military. According to a recent study by the Rand Corporation, active-duty personnel killed themselves at a rate of 16.3 per 100,000 in 2008, up from 10.3 in 2001. Repeated exposure to combat zones may account for this increase. Some soldiers are sent back three or four times before they're off the hook.Maura Kelly is the author of Much Ado About Loving, about what classic novels can teach you about mating, relating, and Internet dating.What were major Battles of the Vietnam War? - The Vietnam WarSuicide Rate Spikes in Vietnam Vets Who Won't Seek Help (2012)Joe Amon/Denver Post/Getty ImagesVietnam Veteran Harold Evans stands with Martin Omafray at the Wall that Heals at Iron Horse Park at Fort Carson in Colorado Springs June 10, 2011.Every Christmas Rudi Gresham, a former combat soldier in Vietnam, gets a Christmas card from a fellow veteran who was nearly pushed to the brink of suicide because of despair."The guy was in his late 50s and his wife had left him and he came down with cancer from Agent Orange, he was broke and he had to move in with his mom and dad--he didn't know where to go from there," said Gresham, who was then serving as senior advisor to the Department of Veterans Affairs under the George W. Bush administration."Everything had gone to hell," said Gresham. "But I communicated with him."Now 68 and retired in South Carolina, Gresham was able to get the veteran the 10 years of back pay he deserved by authenticating his service with a commanding officer. Today, the man's cancer is under control and he has a new woman in his life.Gresham said getting that thank you card for saving the veteran's life was "the most gratifying moment" in his eight-year career with the VA. "I tell my kids, this is the reward for my work."But three other depressed friends were not so lucky and took their own lives, becoming statistics in a rising tide of suicides among baby boomers, many of them Vietnam War veterans.Just this week the Centers for Disease Control and Prevention (CDC) released its latest statistics on suicide rates among Americans, finding that the number of middle-aged Americans who took their own lives was up more than 28 percent.Annual suicide rates among U.S. adults aged 35 to 64 increased from 13.7 to 17.6 suicides per 100,000 people between 1999 and 2010.The greatest increases in suicide rates were among people aged 50 to 54 years (48 percent) and 55 to 59 years (49 percent).For the whole population, the national rate was 12.4 per 100,000 in that decade, according to the CDC. The most common mechanisms were suffocation or hanging, poisoning and firearms. Increases were seen among both men and women.The CDC cites the recent economic downturn, a "cohort effect" among baby boomers who had unusually high suicide rates during their adolescent years, and a rise in intentional overdoses because of increased availability of prescription opioids.But suicide rates among Vietnam veterans are the highest of any particular group, according to John Draper, project director of the National Suicide Prevention Lifeline.Eight million Americans report suicidal thoughts, and 1.1 million will attempt suicide. An estimated 38,000 will succeed in killing themselves, according to the CDC. Most are male, by a four to one margin, and are single and lack a college education.The suicide rate jumped higher for women (32 percent) than for men (27 percent)."Men tend to be more lonely and have a harder time maintaining and replacing relationships than women, especially when they get into middle age," said Draper. "Men are busy working or tie their relationships to work and when they lose their job, they lose their relationships."Those who are less stable in their personal lives are also less stable in the workforce, he said."I don't have all the answers," said Draper. "But we know about suicide prevention and people who are more socially connected and have a sense of belief and self-worth and are valued at work and in their relationships are way more protected and generally happier people."Post-traumatic stress disorder and associated mental health problems are to blame for many of the suicides among war veterans, according to Draper."The most important thing to remember is we can do something to stop this," said Draper, who, like Gresham, said that communication and support from others can help to prevent suicide.Since 2001, more than two million service members have been deployed to wars in Iraq and Afghanistan. The cost for treating veterans of all eras and conflicts is estimated at $48 billion, according to the Department of Veterans Affairs.PTSD was not even recognized until after the Vietnam War, according to Gresham, who recognized at the onset of his government career in 2000 the importance of increasing the VA budget after predicting the staggering number of cases that were to follow. "I knew mental problems would exceed the physical," he said."I feel sorry for the younger soldiers," he said. "They are now married, got a wife and kids and suddenly come back and they can't find a job. These things all compound."As for the Vietnam veterans, they found less support in the 1960s and 1970s, when they returned from combat service. "The older veterans don't trust the government and they don't go for help," said Gresham.Unlike World War II soldiers who were hailed as heroes, these servicemen returned to "feel a bit outcast and rejected," according to Gresham, who sits on the Vietnam Veterans Foundation.Many of that generation refused to acknowledge they had PTSD and are suffering the consequences later in life. "Believe me, we have a real problem," he said."These guys were the first generation not to trust the guys in the white coats, and they didn't trust the government," said Gresham. "A lot of the Viet vets with PTSD held it in."They didn't want to let their family know their dark secret. They wanted to be in the workforce and be productive like the generation of World War II, but they were not respected by society."The VA in the 1970s was not responsive to the needs of these veterans, he said. "I've seen what has happened to a lot of these older vets."At a town meeting in Los Angeles several years ago, Gresham said he told a group of Vietnam vets. "You know Hollywood was correct when they did the movie the 'Fourth of July' with Tom Cruise. The VA did a lousy job of taking care of vets."But today, according to Gresham, "The VA has made "tremendous efforts to spend lots of money on [PTSD]," he said.In 2007, the VA partnered with the Substance Abuse and Mental Health Services Administration (SAMHSA) to create a dedicated line manned by veterans on the National Suicide Lifeline.The so-called Veterans Crisis Line has fielded more than 250,000 calls a year from veterans and active members of the military, according to Lifeline director Draper."It's a brilliant idea and it's saved taxpayers money and saved lives," he said.Draper said it is too early to see the impact of this collaboration but predicts that CDC suicide numbers will eventually drop, at least among veterans.Gresham, who was involved in the creation of the hotline, is also hopeful. "It's so much better for veterans to get help from other veterans," he said. "There is a strong bond.""If you have suicide thoughts and there's another veteran on the line, you trust your brother, whether it's a man or a woman," he said. "If they have been in combat, there is someone who understands you.""They didn't trust the VA for a long time and now the VA has its arms open," said Gresham. "They do very good work now. They understand the problem."In 1971 speech, John Kerry spoke of the monster created by the Vietnam WarNew VA Study finds 20 veterans commit suicide each day (militarytimes.com) (2016)Pedestrians walk in front of the Department of Veterans Affairs building in Washington, Friday, June 21, 2013. (AP Photo/Charles Dharapak)Roughly 20 veterans a day commit suicide nationwide, according to new data from the Department of Veterans Affairs — a figure that dispels the often quoted, but problematic, "22 a day" estimate yet solidifies the disturbing mental health crisis the number implied.In 2014, the latest year available, more than 7,400 veterans took their own lives, accounting for 18 percent of all suicides in America. Veterans make up less than 9 percent of the U.S. population.About 70 percent of veterans who took their own lives were not regular users of VA services.The new data, being released publicly today, is the most comprehensive suicide study ever conducted by the department.For years, the department has estimated the veterans suicide toll nationwide at around 22 individuals a day, but veterans groups noted numerous gaps in how that estimate was constructed. Most notably, the numbers were based on information from only about 20 states and did not contain full military records from the Defense Department.The new study includes more than 50 million veterans’ records from 1979 to 2014, including every state. The data, compiled over the last four years, also comes from the Centers for Disease Control.VA officials said in a statement that the information will allow them to "inform our suicide prevention programs and policies, especially for groups at elevated risk for suicide, including older and female veterans."Together, the numbers point to a significant mental health risk for individuals who served in the military, though the specific reasons remain unclear.Researchers found that the risk of suicide for veterans is 21 percent higher when compared to civilian adults. From 2001 to 2014, as the civilian suicide rate rose about 23.3 percent, the rate of suicide among veterans jumped more than 32 percent.The problem is particularly worrisome among female veterans, who saw their suicide rates rise more than 85 percent over that time, compared to about 40 percent for civilian women.And roughly 65 percent of all veteran suicides in 2014 were for individuals 50 years or older, many of whom spent little or no time-fighting in the most recent wars.Providing support and assistance to suicidal veterans has proven difficult, in part because of the lack of data on the scope of the problem.In recent years, VA has hired 5,300 mental health providers and support personnel and upgraded its Veterans Crisis Line in response to the problem. It has also elevated the profile of its suicide prevention office within the department and launched new partnerships with community health providers to offer counseling to veterans.Officials hope to use the data to further expand those offerings, targeting specific regions and populations within the veterans community to more effectively deliver care.Veterans groups hailed the new research as a critical step ahead in addressing the problem."Of course, this is still 20 [deaths] too many," said Joe Chenelly, executive director at AMVETS. "But we are grateful for the deeper, more accurate data analysis. Much still needs to be done, and this gives us a better idea where to focus."Full year-by-year and demographic breakdowns of the data are expected to be released by the department by the end of July.Leo Shane III covers Congress, Veterans Affairs and the White House for Military Times. He can be reached at [email protected] Kime covers military and veterans health care and medicine for Military Times. She can be reached at [email protected] the Vietnam War, 42 Years After US Troops WithdrewPSYCHOLOGY BENEFITS SOCIETYWe Lose Too Many Vietnam Veterans to Suicide: Here’s How You Can Help (2017)By Meg Lacy (Doctoral Student, Palo Alto University)As our Vietnam veteran population ages, many may become increasingly vulnerable for death by suicide. Despite the fact that the Vietnam war occurred approximately 40 years ago, the moral injuries sustained are still felt by many who served our country. It is not unusual for Vietnam Veterans to have coped with difficult times by staying busy at home or at work. As retirement looms, it is not unusual for Vietnam era veterans to experience additional age-related risks such as social isolation, a feeling of burdensomeness, and changes in health status.These changes can coalesce to hamper coping strategies that previously worked to manage mental distress, such as depression and posttraumatic stress disorder. Alcohol and substance use increases the risk of suicide as the abuse of substances, particularly alcohol, is strongly associated with both suicide attempts and deaths. So what should friends and family watch out for and what could be done in response to warning signs?Warning signs:In general, individuals most at risk of suicide are white older adult males who have health issues. As risk factors associated with veteran status converge on risk factors associated with later life, there are a few specific things friends and family should be aware of.What’s going on in their life?A major change in routine including retirement or loss of a jobThe death of a spouseA new medical diagnosisA break-up, separation or divorceNot having a stable place to liveInadequate family incomeHow are they behaving?Increase in drinking or drug useSleeping considerably more or lessA loss of interest in things they typically enjoySocial withdrawalImpulsivity – engaging in risky behavior (running red lights, driving recklessly, looking like they have a “death wish”)Becoming aggressive- examples of this are punching holes in walls, seeking revenge, getting into fightsAnxiety- worrying excessively about things they cannot controlAgitation and mood swingsPutting affairs in order such as giving away prized possessions or making out a willSeeking out firearms access to pillsNeglecting personal welfare including deteriorating physical appearance or hygieneWhat are they saying?A sense of hopelessness: “I have no purpose”, “I have no value”, “Nothing is ever going to get better”Rage or anger: expressed toward people or thingsExpressed feelings of excessive guilt, shame or failure: “My family would be better off without me”Feelings of desperation: “There is no solution”, “I just feel trapped”What do they have access to?Familiarity and access to a firearm make suicide by firearm more likely. Any means by which a suicide can be attempted, including pills, is something that should be asked about. Veterans are more likely to own a gun and are comfortable using one making death by firearm a common means of suicide among this population.How can you help?Social support is one of the most effective protective factors against suicide (Cummings et al., 2015). However, many veterans have isolated themselves and their friends and family struggle to talk to them. Inviting them to an event, writing them a letter or participating in a shared activity (building something, fishing, walking, etc.) are great ways to get things started.Talk about it. Suicide is an uncomfortable topic but its best to be direct. Ask overtly if they are planning on killing themselves or have had thoughts about killing themselves. Just because they say no doesn’t mean that they don’t still have suicidal intentions so be sure to have additional information to provide such as a suicide hotline number for veterans, apps they could utilize (PTSD Coach), or a therapist’s contact information.If your loved one has a plan or tells you they are going to kill themselves, call 911. It's better to put their safety first. Demonstrating your support by seeking additional help is always best. If you can, include them in the process of seeking immediate help. Calling 911 or visiting the ER does not have to be a one-sided decision.These by no means are the only risk factors, signs or solutions for suicidality. However, engagement with friends and family has shown to be extremely effective against suicide. Demonstrating your support with regular calls or visits is an important step toward safety for many veterans.Related Resources:Veterans Crisis LineAPA Psychology Topic: SuicideResources for Caregivers of Service Members and VeteransWhen Will We Face the Facts about Suicide in Older Men?References:Chronic PTSD in Vietnam combat veterans: Course of illness and substance abuse (1996). American Journal of Psychiatry, 153(3), 369–375. doi:10.1176/ajp.153.3.369Conner, K. R., Britton, P. C., Sworts, L. M., & Joiner, T. E. (2007). Suicide attempts among individuals with opiate dependence: The critical role of belonging. Addictive Behaviors, 32(7), 1395–1404. doi:10.1016/j.addbeh.2006.09.012Conwell, Y., Van Orden, K., & Caine, E. D. (2011). Suicide in older adults. The Psychiatric Clinics of North America, 34(2),. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3107573/Cummins, N., Scherer, S., Krajewski, J., Schnieder, S., Epps, J., & Quatieri, T. F. (2015). A review of depression and suicide risk assessment using speech analysis. Speech Communication, 71, 10–49. doi:10.1016/j.specom.2015.03.004Identifying signs of crisis. Retrieved February 26, 2017, from https://www.veteranscrisisline.net/SignsOfCrisis/Identifying.aspxLambert, M. T., & Fowler, R. D. (1997). Suicide risk factors among veterans: Risk management in the changing culture of the department of veterans affairs. The Journal of Mental Health Administration, 24(3), 350–358. doi:10.1007/bf02832668Lester, D. (2003). Unemployment and suicidal behaviour. Journal of Epidemiology & Community Health, 57(8), 558–559. doi:10.1136/jech.57.8.558Military Suicide Research Consortium (MSRC) Newsroom. (2017, January 28). Retrieved February 26, 2017, from https://msrc.fsu.edu/news/study-reveals-top-reason-behind-soldiers-suicidesNademin, E., Jobes, D. A., Pflanz, S. E., Jacoby, A. M., Ghahramanlou-Holloway, M., Campise, R., Johnson, L. (2008). An investigation of interpersonal-psychological variables in air force suicides: A controlled comparison study. Archives of Suicide Research, 12(4), 309–326. doi:10.1080/13811110802324847Price, J. L. (2016, February 23). Findings from the national Vietnam veterans’ readjustment study. Retrieved February 26, 2017, from http://www.ptsd.va.gov/professional/research-bio/research/vietnam-vets-study.aspUnited States Department of Veterans Affairs. (July 2016) VA Suicide Prevention Program: Facts about Veteran Suicide. Retrieved from https://www.va.gov/opa/publications/factsheets/Suicide_Prevention_FactSheet_New_VA_Stats_070616_1400.pdfVan Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76(1), 72–83. doi:10.1037/0022-006x.76.1.72Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner Jr, E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575.Warning signs of crisis. Retrieved February 26, 2017, from https://www.veteranscrisisline.net/SignsOfCrisis/Biography:Meg Lacy is a first-year doctoral student at Palo Alto University. She is interested in researching early intervention to trauma in combat soldiers and amongst first responders. Additionally, she is interested in the veteran population and suicide prevention.Image source: Flickr user Elvert Barnes via Creative CommonsStoned in Combat: Weed Smokers in the Vietnam War

Q. Can those with graduate degrees in Medical Physics become a radiologist without attending a medical school?A. Physics would be most applicable to the specialties of Diagnostic Radiology, Nuclear Medicine and Radiation Oncology.TN's answer to Would knowing physics be an advantage for a medical doctor?MEDICAL PHYSICIST (aapm.org)What do Medical Physicists Do?Medical physicists are concerned with three areas of activity: clinical service and consultation, research and development, and teaching. On the average their time is distributed equally among these three areas.Clinical Service and ConsultationMany medical physicists are heavily involved with responsibilities in areas of diagnosis and treatment, often with specific patients. These activities take the form of consultations with physician colleagues. In radiation oncology departments, one important example is the planning of radiation treatments for cancer patients, using either external radiation beams or internal radioactive sources. An indispensable service is the accurate measurement of the radiation output from radiation sources employed in cancer therapy. In the specialty of nuclear medicine, physicists collaborate with physicians in procedures utilizing radionuclides for delineating internal organs and determining important physiological variables, such as metabolic rates and blood flow. Other important services are rendered through investigation of equipment perfor­mance, organization of quality control in imaging systems, design of radiation installations, and control of radiation hazards. The medical physicist is called upon to contribute clinical and scientific advice and resources to solve the numerous and diverse physical problems that arise continually in many specialized medical areas.Research and DevelopmentMedical physicists play a vital and often leading role on the medical research team. Their activities cover wide frontiers, including such key areas as cancer, heart disease, and mental illness. In cancer, they work primarily on issues involving radiation, such as the basic mechanisms of biological change after irradiation, the application of new high-energy machines to patient treatment, and the development of new techniques for precise measurement of radiation. Significant computer developments continue in the area of dose calculation for patient treatment and video display of this treatment information. Particle irradiation is an area of active research with promising biological advantages over traditional photon treatment. In heart disease, physicists work on the measurement of blood flow and oxygenation. In mental illness, they work on the recording, correlation, and interpretation of bioelectric potentials.Medical physicists are also concerned with research of general medical significance, including the applications of digital computers in medicine and applications of information theory to diagnostic problems; processing, storing, and retrieving medical images; measuring the amount of radioactivity in the human body and foodstuffs; and studying the anatomical and temporal distribution of radioactive substances in the body.Medical physicists are also involved in the development of new instrumentation and technology for use in diagnostic radiology. These include the use of magnetic and electro-optical storage devices for the manipulation of x-ray images, quantitative analysis of both static and dynamic images using digital computer techniques, radiation methods for the analysis of tissue characteristics and composition, and the exciting new areas of computerized tomography and magnetic resonance imaging for displaying detailed cross-sectional images of the anatomy. Medical physicists are also engaged in research and development on imaging procedures utilizing infrared and ultrasound sources.Typical examples of the various research areas presently under active investigation may be found in scientific journals dedicated to this field. The journal, Medical Physics, is published by the AAPM. In addition, the AAPM holds two national scientific meetings a year, one in the summer and one in the winter. During the winter meeting, the AAPM conducts scientific sessions in joint sponsorship with the Radiological Society of North America. Special summer courses, workshops, and frequent regional meetings are also held by the AAPM.TeachingOften medical physicists have faculty appointments at universities and colleges, where they help train future medical physicists, resident physicians, medical students, and technologists who operate the various types of equipment used to perform diagnosis and treatment. They also conduct courses in medical physics and aspects of biophysics and radiobiology for a variety of gradu­ate and undergraduate students. The Commission on Accreditation of Medical Physics Education Programs, Inc. (CAMPEP), jointly sponsored by the American College of Radiology (ACR), American Association of Physicists in Medicine (AAPM) and the American College of Medical Physics (ACMP), assures high educational standards in the field. A list of accredited programs is available here.Medical Physics - MedicalPhysicsWebWHAT IS MEDICAL PHYSICS?IntroductionUltrasound, Magnetic Resonance, Computed Tomography, Nuclear Medicine, X-rays, Radiation Therapy, are all branches of medical physics where continued research is being conducted by a very large group of dedicated researchers consisting of highly qualified physicists, engineers and radiologists. The field of medical physics as we know it today started with the discovery of x-rays and radioactivity in the 1890's. The first radiograph was taken by the physicist Wilhelm Conrad Roentgen (1845-1923) in his Wurzburg University laboratory in Germany. It was a radiograph of his wife's hand. For his thorough scientific investigations of x-rays he received the first Nobel prize in Physics in 1901. Follow the links at Emory to share in the excitement of those historical months of January and February 1896.Physicists were also pivotal in using radiation as a treatment for cancer. We can be very proud that Canadian physicist, Harold Johns (1915-1998), developed in the late 1940s the first Cobalt Therapy Unit. For his continued dedication and research he was made an Officer of the Order of Canada in 1976. The medical profession also honoured Dr. Johns by inducting him into the Canadian Medical Hall of Fame in 1998.Physicists have contributed positively to the advancement of the diagnostic and therapeutic fields of medicine. They will continue to play a primary role in the development of physical principles to medicine.Who are Medical Physicists?Medical physicists are health care professionals with specialized training in the medical applications of physics. Their work often involves the use of x-rays, ultrasound, magnetic and electric fields, infra-red and ultraviolet light, heat and lasers in diagnosis and therapy. Most medical physicists work in hospital diagnostic imaging departments, cancer treatment facilities, or hospital-based research establishments. Others work in universities, government, and industry.What do Medical Physicists do?Most medical physicists work in one or more of the following areas:Clinical ServiceThe responsibilities of a clinical medical physicist lie predominantly in the areas of radiotherapy and diagnostic imaging. The roles of a medical physicist in radiotherapy include treatment planning and radiotherapy machine design, testing, calibration, and troubleshooting. The roles of a medical physicist in diagnostic imaging include machine purchasing and installation, testing, quality control, and operation.Radiation SafetyMedical physicists have expertise in radiation safety. Canadian regulations recognize medical physicists who are certified by the Canadian College of Physicists in Medicine as Radiation Safety Officers for medical radioisotope facilities.Research and DevelopmentCanadian radiotherapy physicists play a central role in such areas as the design and construction of radiotherapy treatment equipment, the use of heat and lasers in cancer treatment, the theory of radiation absorption and dose calculation and in radiobiology. Imaging physicists are continually developing and improving methods to image body structure and function. Canadian laboratories are leaders in positron emission tomography, magnetic resonance imaging, ultrasound, x-ray and radionuclide imaging, biomagnetic mapping, among other areas. Excellence in Canadian Medical Physics Research is recognized annually via the awarding of the Sylvia Fedoruk Prize.TeachingMost medical physicists are affiliated with universities. Many medical physicists teach in graduate and undergraduate medical physics and physics programs. They also teach radiology and radiation oncology residents, medical students, and radiology, radiotherapy, and nuclear medicine technologists.Professional statusMost Canadian medical physicists belong to the Canadian Organization of Medical Physicists (COMP). COMP promotes the application of physics to medicine through scientific meetings, technical publications, educational programs, and the development of professional standards. COMP is linked to medical physics organization in other countries through the International Organization of Medical Physics.Many Canadian medical physicists are also members of the the Canadian College of Physicists in Medicine (CCPM), which was established in 1979 to recognize proven competence in physics as applied to medicine. Candidates with suitable educational background and experience become members of the college by passing written and oral examinations. CCPM certification is becoming widely accepted in Canada and other countries and is often required at senior levels in medical physics. Each year the college supports continued professional education by sponsoring symposia on specialized topics and by providing a travel award for a young member in honor of Harold E. Johns.Employment of Medical Physicists in CanadaThere are approximately 550 medical physicist members working in Canada: 75% work in hospitals and hospital-based research establishments, 7% work for government, 8% for industry, and an additional 10% are university faculty who are not hospital-based. The number of medical physics positions has generally increased by about 5-10% per year.Medical Physics Training ProgramsA prospective medical physicist should first have an honors degree in physics. Courses in computing, electronics, and mathematics are advantageous. They may then undertake graduate work in medical physics or another area of physics followed by a one or two year training program in medical physics. Many universities and clinics across Canada provide training programs and also introduce undergraduate students to medical physics through summer employment programs.What Is a Radiation Physicist?Radiation physicists, also known as medical physicists, are scientists who specialize in studying how radiation can be used for medical purposes. Depending on their particular area of interest, they may conduct experiments on how radiation can be used to diagnose disease or how it can be used for medical interventions and therapies. They must also pay close attention to safety concerns when using this technology for health-related purposes. Based on the results of their experiments, they prepare them for presentation to the medical community, often in the form of academic journal articles.The following table provides information for this career:Degree RequiredMaster's degree and doctorate in physics-related field.Education Field of StudyMedical physics, radiological physicsCertificationBoard certification required by many states and employersKey ResponsibilitiesCalculate, operate and manage the design of equipment, follow all safety precautions, consult with medical professionals on patient treatmentsJob Growth (2014-24)8% (physicists)*Median Salary (2015)$111,580 (physicists)*Source: *U.S. Bureau of Labor StatisticsWhat Are the Job Duties of a Radiation Physicist?As a radiation physicist, you would handle the technical aspects of radiological equipment including managing the design and operation of equipment. You might calculate the strength of equipment, calculate the dosage of radiation and ensure proper safety precautions are in place. You'll consult with doctors and other medical personnel on patient treatments, offering advice about the use or dosage of radiation therapies. You would be the expert in charge of making sure radiation therapy is safe and effective for patients and those administering care.You may work at hospitals, clinics and other medical facilities where radiation therapy is used. You might work on staff at a medical facility or you may work independently and go where you are needed to help with the installation and initial setup of a new system. You might even work for a network of hospitals, offering radiation expertise at the various hospitals and medical facilities within the network.What Education Will I Need?In order to qualify for certification, a radiation physicist must hold a bachelor's degree in physics and a master's degree or doctorate in medical physics, radiological physics or a related degree. In a physics program, you'll take core classes in science, mathematics and computers. You will also study physics in-depth through learning about theories, mechanics, statistics and electricity. Graduate programs also include research study and may involve writing a research paper.What Are My Certification Options?Many states and employers require radiation physicists to be professionally certified. The American Board of Radiology (ABR) offers board certification in radiology (ABR). To earn board certification, you must prove your knowledge and skills of radiology through a series of assessment exams. You must also have a graduate degree in the field and at least three years of experience working under a certified radiation physicist in a clinical environment.The American Board of Medical Physics (ABMP) offers certification in magnetic resonance imaging (MRI) and medical health physics (The American Board of Medical Physics). The MRI physics certification tests your knowledge of MRI operations and technology. The medical health physics certification tests your knowledge of radiation procedures and standards. Certification requirements include a graduate degree from an accredited radiation physics program.Medical Physics - Medical Physics - The Graduate School of Biomedical Sciences at HoustonMedical Physics OnlineMedical physics - WikipediaMedical physics (also called biomedical physics, medical biophysics or applied physics in medicine) is, generally speaking, the application of physics concepts, theories and methods to medicine or healthcare. Medical physics departments may be found in hospitals or universities.File:Parasagittal MRI of human head in patient with benign familial macrocephaly prior to brain injury (ANIMATED).gif - WikipediaIn the case of hospital work, the term medical physicist is the title of a specific healthcare profession, usually working within a hospital. Medical physicists are often found in the following healthcare specialties: diagnostic and interventional radiology (also known as medical imaging), nuclear medicine, radiation protection and radiation oncology.University departments are of two types. The first type are mainly concerned with preparing students for a career as a hospital medical physicist and research focuses on improving the practice of the profession. A second type (increasingly called 'biomedical physics') has a much wider scope and may include research in any applications of physics to medicine from the study of biomolecular structure to microscopy and nanomedicine. For example, physicist Richard Feynman theorized about the future of nanomedicine. He wrote about the idea of a medical use for biological machines (see nanobiotechnology). Feynman and Albert Hibbs suggested that certain repair machines might one day be reduced in size to the point that it would be possible to (as Feynman put it) "swallow the doctor". The idea was discussed in Feynman's 1959 essay There's Plenty of Room at the Bottom.Healthcare scientist, medical physics