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Post Traumatic Stress Disorder

September 26 2009
Bywater: exposure to trauma can have a detrimental effect Bywater: exposure to trauma can have a detrimental effect
Humans‘ reactions to cope with the trauma of war are still badly understood Post Traumatic Stress Disorder is often spoken of and is little understood. "I can recall an unconscious man who arrived with part of a frontal lobe protruding through a hole in his skull. The protruding portion of his brain was moving with maggots. Maggot invasion was always accompanied by a foul smell. I saw more human tissue than one would have thought possible... The carnage of the Somme was enormous." - Memoirs of Captain L Gameson. "...the next thump hit Steve in the elbow, spinning him around... CRACK, another round tore into the side of his neck, ripping open a flap of skin and tissue to expose his windpipe. It all seemed to be happening in slow motion and Matt could only watch as Steve's eyes rolled backwards and his mouth fell open to gasp his last breath." - Honourable Retribution, by Simon Bywater These accounts of war span almost 90 years, one fought in Europe in 1916 and one in the Middle East in 1991. The way in which wars are fought today differ vastly, but what is apparent from these extracts is that the horrors of war have changed little, nor has humans' capacity to process and cope with the trauma. Of course, people react differently to different situations and many do cope. However, for some members of the armed forces, the experiences of operational combat can haunt them for years with devastating effects. And as we mark the anniversary of the Battle of the Somme, where 20,000 men were killed in one day of carnage, we look at how far-reaching the psychological impact of war can be, and ask how far we have come in supporting those ex-service personnel who are suffering from it. Shell shock, battle fatigue, war neurosis and hysteria were just some of the labels given to the thousands returning from the Western Front in 1918. Today, the condition is widely known as combat-related Post Traumatic Stress Disorder (PTSD). During World War I, shell shock was a forbidden term. Captain Gameson, a medical officer in the 45th Field Ambulance, detailed his appearances at courts martial to defend those suffering from this controversial illness. One account recalls his evidence at the trial of a soldier who had been accused of desertion in the face of enemy fire. Gameson wrote: "I was also prepared to question why the boy's instability had not been detected and reported. My evidence was taken down and received in silence without comment. I was told later that cowardice had been established and a verdict of guilty found." The soldier was later shot. The lucky ones were placed in lunatic asylums as the debate about the authenticity of shell shock raged on. In 1919 the Ex-Services Mental Welfare Society was formed to support returning veterans in a society where there was little or no sympathy with the psychological scars of war. The Society was visionary and a pioneer of rehabilitative aftercare and treatment for those suffering after the Great War. Since it was founded, Combat Stress, as it is now known, has assisted over 85,000 veterans coping with PTSD and currently supports 7,000 sufferers. According to Combat Stress, the definition of PTSD is "a pervasive illness that can affect every aspect of a person's life. Suicide, homelessness and relationship breakdowns can all result from PTSD." Symptoms include insomnia, recurring nightmares, flashbacks, severe mood swings, hyper alertness and violent and aggressive outbursts. In addition to this, the sufferer may seek peace with alcohol and drugs, further masking the real source of the problem. The average length of time between leaving service and seeking help is 14 years, so those who have PTSD live a life of silent pain for a long time. And there are no figures on the number of rough sleepers with PTSD, nor of the affect it had on them. This is largely because of the lack of detailed research on whether there is a link. The current Ex-Service Action Group (ESAG) report states that "ex-service people are also more likely than those without a services background to have support needs related to alcohol problems and mental health needs", though this is not defined as PTSD. Another frightening statistic is that more returned veterans have committed suicide since the Falklands Conflict than actually died in the fighting. Clive Walch is a regional welfare officer for Combat Stress and covers the London area. He told us: "From my experience as a welfare officer for London, Herts, Beds and Bucks, there is a direct link between clients who suffer from PTSD ending up as homeless or rough sleepers." And if the leading organisation on PTSD admit outcomes that can all potentially lead to a life on the streets, then surely more focused research is needed. According to Clive Walch this is an area being looked at. "Combat Stress have a research project on progress and are currently awaiting statistics," he said. Simon Bywater was one of the lucky ones; he readily admits that without the continued support from his family, he doesn't know where would have ended up. Bywater fulfilled his lifelong ambition of joining the Royal Marines and was attached to 40 Commando. He recalled: "I served all over the world with them on training exercises. It was very exciting." He soon found, however, that exercise and operational theatres were poles apart. "An exciting lifestyle and facing the realities of death are two very different things, and being exposed to such traumas can have a detrimental effect in later life if they are ignored. That certainly happened to me." His first book, Forced Out, relives his experiences and was a cathartic process. He told The Pavement: "It was my way of exorcising my own feelings of guilt and responsibility. For years I never talked about what I had seen and done." Bywater believes that post-discharge care was lacking. He returned from the Gulf in 1991, having been discharged without any support. He remembered returning home: "I stepped off the plane with no welcome. I had to call my wife to say I was home. Two weeks later, I was on the dole in Manchester. No one ever asked if I was okay." He then worked for 10 years in the police force. He encountered many ex-service personnel who were living on the streets, having found it difficult to adjust to civvy street for a number of reasons. This inspired him to write his second novel, Honourable Retribution. Drawing on his and others' experiences, Honourable Retribution tells the story of Matt, whose PTSD is so severe he takes to a life on the streets to redress what he sees as society's injustices. The book's resolution is bloody. Bywater explained: "The conclusion of Honourable Retribution questions society's ignorance of homeless people that we pass every day on the streets. It's a warning. Could a traumatised serviceman react like this if he is left untreated?" Ex-service rough sleepers suffering from PTSD slip through the net easily. Sufferers in this position might find it difficult to access the same support, as Combat Stress requires a permanent address and a GP before they can assess a client. Richard Partridge, a SSAFA Forces Help caseworker based at St Martin's-in-the-Field, recognises this as a problematic area when someone presents with PTSD. He told us: "There is a requirement for medical intervention," and accessing day centres that offer medical advice services is key. "Skilled medical staff will refer clients as out-patients, leading to treatment through the NHS," he said. The network of exservice hostel accommodation also provides a vital service. Trained staff are able to identify PTSD, and once clients are referred, the centres can provide the necessary support. Today Combat Stress is still the only organisation to offer PTSD support for ex-service personnel. As a result they are under resourced and overworked. Their users have, between them, served in every campaign since World War II, and it is anticipated that the number of cases will increase as a result of the ongoing conflicts in Iraq and Afghanistan. The good news is the MOD now officially recognises PTSD as a service injury and will award a war pension. The bad news is they usually assess the injury below the threshold required for them to pay for treatment. Post-service support for PTSD is improving, but it is clear that much work still needs to be done. Stiff upper lips are long gone and this is a time where, for those who are suffering, silence is not golden. Forced Out and Honourable Retribution by Simon Bywater, are published by The Book Guild Ltd. The memoirs of Captain L Gameson appear courtesy of the Imperial War Museum.
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