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The opening flashback
Why would Kien start the novel as if the reader were in the Vietnam War? Simple: For Kien to explain what PTSD feels like in his life, the reader must endure a gruesome flashback. The effect is that Kien can remember the trauma like it is still happening. The audience doesn't know that it's happening though, so there's a situational irony.
Bao Ninh's appearance in the novel
Bao, perhaps knowing that his work would be dismissed as fiction, uses a clever fourth-wall break in his novel, writing himself into the novel to explain why he is writing Kien's story. The unlikely appearance of the author in his own fictional novel is that it makes the reader question the truth or fiction of the stories.
The irony of the ended war
Does the war ever really end for Kien? Not really, because as he captures in the first scene, even after the war ends, the trauma continues with a vengeance. The fact that the novel begins with the end of the war is ironic, and the effect of the irony is that the novel is about the horror of war and the life of PTSD—not necessarily the war itself.
The suffering sacrifice of Phuong
When Phuong sacrifices her life, she is coming from having been raped. Ironically, her experience of horror and suffering from the rape did not stop her from sacrificing her life for Kien's, and Kien's thanks for her sacrifice is religious in nature, because she was something of a messiah for him. She volunteered for more suffering rather than letting Kien suffer.
The irony of literature
For a person with PTSD, talking about the trauma is often not a good idea, because the mind can always retraumatize itself. However, Kien decides sacrificially to share his experience because he feels it holds some sort of ethical or religious value to the future people who may not believe humans are capable of such horrifying warfare.
Bao explains at the end of the book that Kien has passed away, but that in his final days, he benefited from his memory which no longer plagued him with images of hell. Now, having told his stories, Kien was finally able to use his memory to remember his younger, blissful years. The argument is that Kien's decision to share his suffering made it more bearable.
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