As another year passes and Remembrance Sunday is upon us once more, I find myself recalling the dissertation I wrote on Post Traumatic Stress Disorder (PTSD) back in 2003. The thesis was the final submission of a three-year BSc (Hons) in Public Health. The motivation behind the thesis was my brother Ian. Ian had not had many opportunities in his life, a lack of a significant male role model had been instrumental in his decision to pack his bag at the age of 17 and go off to join the Royal Marine Commandos. I recall how proud we all were when attending his ‘pass out’ parade in Lympstone, Devon, little did we know what would happen on the next few years.
On April 2nd, 1982, Argentine forces occupied the Falkland Islands. A British Task Force of some 28,000 military personnel were despatched by the British Government to recapture the islands. In total the conflict lasted just 74 days, during which time 255 service men and women lost their lives. However, according to the South Atlantic Medal Association and Campaign for Truth (SAMA 2002, Campaign for Truth 2003) more service men and women have committed suicide since the Falklands War than the number who died in the conflict. This is not a new occurrence; similar events have been recorded following other wars.
More than 115,000 Vietnam veterans have died since their return to the United States, more than twice the number killed in action, and as many as 55 % of those deaths were confirmed as suicides. Zahava Solomon of the Israeli Defence Forces Medical Corps has written extensively on combat stress and the enduring toll of war. Writing of his personal involvement in the Lebanon War 1982, he details cases of suicide attempts among his colleagues suffering symptoms of combat stress, and stated that:
‘Suicide is a vast public health crisis that makes us so uncomfortable that we divert our eyes from it.’ (Solomon 1993, P97)
PTSD is a natural emotional reaction to a deeply shocking and disturbing experience. It is a normal reaction to an abnormal situation. It was not until 1980 that PTSD was first given full recognition in the Diagnostic and Statistical Manual Version Three (DSM-III) of the American Psychiatric Association (1980) and its international equivalent, the World Health Organisation ICD-10 (Classification of Mental and Behavioural Disorders 1992).
When making the decision to undertake this study in 2003, the overriding question for me was ‘if 200 combat personnel encounter the same significant traumatic event as would be experienced during battle, then why do some and not all develop symptoms of PTSD’? For some combat veterans, relief from the primary symptoms of PTSD is a struggle for much of the post-war adjustment period. Moreover, secondary problems associated with living with trauma have a substantial impact on veteran’s sense of self and capacity for interpersonal relationships. A study by Jackley (2001) specifically investigated how shame and inadequate sense of self were related to PTSD. On the battlefield, apart from the ordinary stresses of being away from one’s family and friends, professional service men and women find themselves suffering frequent bereavement, at an age when the majority will not have encountered death first-hand. They live hourly with a sense of danger and personal vulnerability in addition to the horrors they witness and the terrible things they may find themselves doing. When the conflict is over, referred to as the ‘Aftermath’, memories can be difficult to handle. Problems are often compounded by the inability to seek help due to the stigma which is still attached in disclosing symptoms of mental health illness.
My brother was badly wounded in the Falklands War, on Friday 11th June 1982, at the battle known as ‘Two Sisters’. He lay wounded for three hours because the medical helicopters could not get to the wounded whilst the battle raged on. Luckily, after a lengthy period of convalescence he recovered from his physical injuries. However, the mental scars slowly began to show themselves. The man who went to fight for Queen and country was never seen again, in his place returned a stranger.
Mental distress is an invisible injury, the unquiet mind, the one society does not or cannot see. My brother was eventually diagnosed with PTSD but this was many years after the Falklands conflict. Prior to his diagnosis I had asked him numerous times to seek medical attention, but he would just reply, ‘what would the point be, no one will understand’? He was right. I still have images of Ian inflicting unbearable acts of self-harm, being absorbed with self-loathing, worthlessness and survivor guilt. I recall speaking with him about his experience and asking him what he had expected when he joined up? Surely, he knew what the job was, he had undergone an intense training programme specifically designed to turn him and his fellow marines into the ultimate fighting machines. His response, ‘no amount of training can prepare you for the reality of war’.
I interviewed many veterans to inform my study and applied ‘thematic analysis’ to make sense of my findings. The stories were the same, the lack of support when they returned from conflict was identified as one of the overriding themes.
To support veterans through PTSD the best outcomes were achieved when the support came from ‘experts by experience’, those who had lived it themselves. I would welcome the opportunity to revisit the study to see if anything has changed since 2003. There have sadly been many more conflicts since the Falklands in 1982, not least those in Afghanistan and Iraq. It is welcome and encouraging to see Prince Harry commit his time and energy to supporting veterans through the Invictus games and other activities. He is an ‘expert by experience’, he has lived the reality of conflict and he now uses is status and royal position to do all he can in support of returning servicemen and women. For this I applaud him.
My brother has found his peace, he lives a quiet, healthy life in Mexico. He will always have a strong comradeship and affiliation with the Royal Marines, this year he travelled to Arbroath in Scotland to take part in the 25th anniversary of the Falklands conflict and show his continued respect to his fallen comrades.
Royal Marine Commandos: ‘Per Mare, Per Terram’ “By Sea, By Land”.
Marines Don’t Cry
We sat down for a while when we came ashore
Was this what we have come so far to fight for?
This bleak and desolate piece of land
Then an islander held out her hand
Her smile so wide, a tear in her eye
Now I knew the reason why.
We gave of body and of soul
We would reach the final goal
So many friends and comrades left behind
For many this still plays on the mind.
20 years on, time again to say goodbye
Not now an islander with a tear in the eye.
Grown men they say should not cry.
Colin Waite
Royal Marine, June 2002.
