Overdosing on post-traumatic stress disorder
What’s really striking about British soldiers in Afghanistan is not their vulnerability, but their resilience.
Monday’s edition of the BBC current-affairs programme, Panorama, offered a shocking view of the effect of recent wars on former UK servicemen and their treatment by the Ministry of Defence (MoD). The opening of the programme was blunt: ‘More and more British soldiers are suffering from post-traumatic stress disorder [PTSD], haunted by what they experienced in war. More soldiers and veterans took their own lives last year than were killed by the Taliban.’
The stories of personal tragedy featured in the programme were certainly moving. The first was that of Lance Sergeant Dan Collins, a member of the Welsh Guards who had served in Afghanistan. Collins was certainly up for the fight, as a clip of him in action during the conflict demonstrated. He was clearly someone who relished the business of being a soldier.
Yet Collins was later involved in a number of horrendous incidents in battle, as Toby Harnden – the journalist who presented Panorama – explained in a newspaper article last year after Collins killed himself. Most notably, having come close to being shot himself, and having tried and failed to save a colleague whose legs and arm had been blown off, Collins was badly affected when his close friend was killed by a Taliban bomb.
Collins began suffering nightmares and was diagnosed with PTSD. However, he was never able to return to his battalion and suffered a profound depression. On New Year’s Day 2012, he hanged himself after leaving a heart-rending video for his mother.
In the programme, Harnden focused on the testimony of a number of families, on how their sons, brothers and partners had been traumatised by events in battle and how the support offered to them after leaving the army appeared inadequate. Important paperwork about serious mental problems was not passed on to family doctors and there was an apparent lack of proper psychiatric support. As one family member put it, if there are specialist rehabilitation units for men with physical injuries, why not for those suffering serious mental anguish?
Such anecdotal evidence suggests the MoD is not living up to the promise that it will take care of those who fight for their country. But to what extent is there a new and widespread problem? It was difficult to tell because Harnden did not put the levels of PTSD and suicide into any context, other than to read out a MoD statement: ‘Suicide among the armed forces remains extremely rare. Rates of suicide and PTSD are lower than comparative rates in the civilian population.’
In an article for the Independent on Monday, Simon Wessely, professor of psychological medicine at King’s College London and one of the country’s foremost experts on military mental health, urged caution about some of the claims made by Panorama. In particular, Wessely and his colleague Nicola Fear questioned whether it made sense to compare the number of deaths in action in Afghanistan with the number of suicides among all military veterans, not just those who had been in Afghanistan. Moreover, rates of PTSD in the army seem fairly steady at four per cent, but sufferers are now quicker to report problems than in the past, which may, Wessely and Fear argued, explain an apparent increase in the number of PTSD sufferers in recent years.
I got in touch with Wessely to pick his brains further on the issue. For example, are servicemen more likely to suffer mental illness than civilians? ‘Overall no, but yes in certain groups – namely those in combat roles and those who are reservists’, says Wessely. ‘We have shown that both have an increased risk of PTSD after deployment. However, there is no increase simply in regular forces who have deployed – it depends on your role and background.’
Nor, he tells me, is it simply the case that the more terrible the experience, the greater the trauma. ‘First, of course, it is not just about the battlefield – I don’t know any study that doesn’t show that this is multi-factorial. So background plays a role – who you are is important, just as what happens to you. Second, it is not just exposure to trauma, it is about its meaning. It is, for example, one thing to be shot by the Taliban, it is quite another to be shot by mistake by your own side, in terms of liability to cause PTSD. And then there are big protective factors. For example, we have shown that rates of PTSD are considerably lower in units with good leadership than those with poor leadership.’
I ask Wessely about this issue of meaning. Could it be the case that wars in Iraq and Afghanistan seem distant and purposeless to soldiers, who then struggle to come to terms with terrible incidents when they occur? Perhaps, but for Wessely this is less of an issue than in the past. ‘We have moved from a conscript military to an all-volunteer force. Nowadays people join up because they want to be deployed – they would have to be crazy otherwise. Although patriotism and having a cause are not absent, the main motivation factors are professional – doing a good job, not letting the side down, behaving like a proper soldier, etc.’
However, Harnden’s film does draw attention to an important point: that the scale of these problems isn’t really known. One of Harnden’s main charges is that the MoD does not properly monitor suicide and PTSD among ex-servicemen. Nor do we really know what is happening with PTSD more generally. As Wessely notes. ‘We don’t have any proper population studies of PTSD in the UK. Incredible but true.’ But on the issue of suicide, the matter is clearer, he says: ‘Overall suicide rates are lower in the armed forces than in civilian populations.’ This is partly due to soldiers being in an institution that provides much that is absent from everyday life: comradeship, a strict code of conduct and a sense of a wider purpose. And there are other, more mundane factors, such as the simple fact that people in the army are in employment, whereas unemployment is a factor in suicides elsewhere.
However, there is one group where this is not the case, according to Wessely: ‘The exception is young men (21 and under) in the army, where there is an increase in suicide compared to civilian populations of the same age and gender.’ These are just the kind of men featured in the Panorama report.
Those who stick it out in the army tend to do better. As Wessely points out: ‘The longer you serve, you get more and more resilient (although this is partly because those who develop mental-health problems are much more likely to leave) – and by the time you leave you usually find it easy to get jobs, etc. The ones with problems are what are known as early service leavers – less than four years. They are much more likely to have multiple problems – substance misuse, trouble with law, unemployment, unstable housing, mental-health problems, and poor relationships.’
Amid all the discussion of psychological trauma and suicide, it is worth stepping back and drawing another conclusion. Given the horrific things that occur during these conflicts, the striking thing is the resilience of those involved, not their vulnerability. While Harnden is right to have sympathy with those who have lost a loved one to suicide and who are struggling to understand why it has happened, the portrayal of servicemen as uniquely vulnerable – due to the horrors of war – may actually serve to undermine the toughness that allows the vast majority of soldiers to cope with nightmarish situations and get on with their lives, in and out of the army.
In that respect, this contemporary discussion of service personnel mirrors a wider mood, which suggests that people are unable to cope in the face of adversity, whatever form it takes, whether it is childhood trauma, unemployment or bullying. The notion that we are vulnerable beings unable to cope with, or control, our circumstances is a corrosive idea that should be challenged, however and wherever it appears.
Rob Lyons is commissioning editor at spiked.