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The author summarizes and compares our knowledge of the psychopathology observed in Vietnam veterans with that of veterans of World War II. Clinicians must be aware that the primitive character pathology exhibited by Vietnam veterans is a defensive response to the specific experience of Vietnam combat. Defensive splitting, denial, and projective identification are frequently observed. The author attributes this to the special stress of the Vietnam combat situation, which led to loss or distortion of self-identity, the development of "splits" in the self-system, and pathological killer-victim identifications. Many Vietnam combatants found a temporary solution to their anxiety, fear, and helplessness in an illusion of being an omnipotent survivor. This helped conceal the victim-self identify; but the primitive nature and fragility of this defense left the individual at risk for the emergence of self-destructiveness and other victimization behavior in later life. Those who could develop a "protective self" might have functioned adaptively in combat, but they were at risk of "survivor guilt" if those they aimed to protect were in any fashion harmed; they also retained a propensity for outbursts of massive aggression. The repressed memories of unresolved traumatic events involving abandonment, "betrayal," dehumanization, loss, near-death experiences, and survivor guilt, will be encountered in the course of treatment along with typical post-traumatic symptoms.