“Diving For Dear Life”

by Ashley Browne

 

Thirty years ago I sat on a battered Royal Navy destroyer somewhere off the Falkland Islands, listening to the BBC World Service announce that the Argentine forces on the Falkland Islands had just surrendered.  It was traditional for the BBC to tell us (and the Argentines) things before our own command did, simply because the U.K. Government usually told the BBC first.

Some three months earlier, my friends and I had been merrily drinking our way around the bars of Gibraltar, celebrating the end of a long and fairly tedious naval exercise in the Atlantic.  There had been glimpses in the news of the forthcoming trouble in the South Atlantic but when the story finally broke of the Argentine invasion of the Falkland Islands, our initial reaction was one of ‘where?’  In all honesty, the majority of us had no idea where the place was, there was a rumor that the navigation officer may have known but even that couldn’t be verified.

As we parted company with friends on other ships (a couple of whom, sadly, we would never see again), none of us could really imagine where this journey would take us.  Being as heavily trained as we were, the extra exercises had little impact on us mentally and the accompanying soundtrack of the ongoing negotiations had the misleading but comforting effect that it would all be sorted out before any fighting broke out.  The chilling reality dawned on me when I had to donate two pints of my own blood to be held in the sick-bay chillers “just in case”; nothing hits your 18 year old sense of invulnerability more than watching your own life-force being stored to possibly save your life at a later date.

Fast forward four weeks and we now found ourselves in a truly frightening shooting war and the ship was now very much in the front line and remained so throughout the rest of the conflict. During a series of hard fought air-sea battles against the very useful Argentine air force, this same ship sustained heavy damage and a number of my ship-mates were wounded.  Two of those ships that had been with us in Gibraltar were now at the bottom of the South Atlantic with some of our friends in them.

As might be expected, those dramatic events are still sharply etched in my memory and even after thirty years I can still capture the feelings and sharp emotions that surged through me at the time; the clenched, controlled fear of doing your job under fire, the deafening and intensely metallic sound of battle and the odd sense of almost zombie-like detachment that comes after the adrenalin surge of combat winds down to be followed by twitchy, nervous exhaustion and a few hours of comatose sleep if you were lucky enough that the watch system was in your favor when stood down from action. The general sense of enduring was always there; constant fatigue, cold, damp weather and short rations are my abiding memories of the time but always sweetened by the constant piss-taking humor which can still make me laugh today looking back.  We knew we were far from being an invincible war machine but just had to tough it out, the Royal Navy’s overbearing tradition of not giving up saw to that, rarely mentioned but tangible just the same.

With hindsight, our sound training (the end result of the Royal Navy’s torrid experience during the Second World War) and an ingrained sense of (at times black) humor saw us through physically and mentally. Petty differences were put aside for the duration.  Of a crew of near five hundred, only two men were taken off the ship as a result of what could be considered to be nervous breakdowns.

The Falklands are back in the news here in U.K. and the recent coverage of veterans’ issues combined with a long talk I had with a younger friend who has completed several tours of Iraq and Afghanistan, got me thinking about the effects of the high level of exposure to active service and direct combat on British service personnel and their families and associates in recent years.

Like the United States, the United Kingdom has had one arm or other of its armed forces engaged in active service on a more or less permanent basis since the end of the Second World War, from Korea to Afghanistan, in conflicts ranging from full-blown conflict to policing and peace-keeping operations, some as a result of savage civil wars, such as Bosnia in the mid-nineties.  Putting the politics and rights and wrongs of these conflicts aside, this has resulted in worrying levels of mental disorders among the young men and women involved and has directly impacted families, friends and colleagues who have to pick up the pieces, often with very little help from official channels in the shape of the Ministry of Defence (MoD) and the National Health Service.

All modern armed forces train their personnel to a point where they can cope physically and mentally to be able to carry out their allotted tasks while under extreme conditions that mirror as closely as possible combat situations .  Men and women will be exposed to harsh physical conditions, tiredness, limited rations and repetitive exercises. All of which are designed in quasi-Darwinian way to filter out those incapable of “making the grade” and expanding the concept of what is possible for those that do.

While this induced mental and physical hardening is an obvious prerequisite for men and (more frequently) women engaged in combat, the enforced bottling up of natural emotions and the subsuming of personal feeling into that of the team is almost certainly one of the main root causes of later mental problems including PTSD.  Modern military training is targeted at helping men (and increasingly) women in combat (and other dangerous military situations), overcome the immediate and natural reactions of a human being when faced with a danger.  Programs such as the U.S. military’s “Battlemind” initiative and similar programs in other NATO forces, have been highly successful in preparing troops for a shooting war but are not geared for helping those same troops wind down and rehabilitate into society, when their services on the battlefield are no longer required.  Although the U.S. has recently updated “Battlemind” to take into account post-deployment rehabilitation and help for spouses.

It is probably fair to say that although every major conflict throughout the 20^th and 21^st centuries has produced casualties with wounded minds, the Vietnam War was the one which really focused the Western world on the potential for long term mental harm to troops involved in modern warfare.  The shameful treatment of “shell-shock” sufferers in the First World War is indicative of how poorly the subject was understood at the time, although some effective pioneering work was carried out during that war, particularly by W.H. Rivers and others at Craiglockhart in Scotland (as readers of Pat Barker’s Regeneration trilogy will be aware).  Although the condition was recognized at the time, little or no follow-up research was done on those men that returned from the trenches of France or the Middle East and many of these men lived the remainder of their lives alone with their condition unable or unwilling to share what they had seen with their families.

By the time of the Second World War, advances in clinical psychiatry and the large scale involvement of psychiatrists with the armed forces, had bought about some recognition that men in combat had a limited “shelf-life” if they were not going to suffer long-term mental harm.  This thinking was borne out by later analysis, the fighting effectiveness of troops that had been in combat for 30, 40 and 50 days fell away exponentially, until at 60 days they were effectively incapable of continuing to fight.   Units had to be rotated out of the front line as regularly as could be allowed, in order to recover, both physically and mentally. These men often recovered quickly and one of the key factors in this was that unit integrity was maintained. Surrounded by friends and colleagues of a similar mindset and experience, they were able to reconcile their experiences and recognise that their unit provided a support mechanism, effectively a surrogate family.  I can remember conversations with my own grandfather (a veteran of France, Dunkirk and the Western Desert) on the subject and recognizing from my own experience, the importance of the bonds of those friendships to our well-being. Nothing describes it better than Shakespeare’s ‘Band of Brothers’ speech from Henry V, at that moment in time it is genuinely a form of love.

The Vietnam War produced its own set of special problems for the troops involved.  After the early phases of the war, men were drafted into units piecemeal with little acclimatisation time, the unit integrity and support mechanisms of the Second World War were often lacking and the war ultimately became unpopular at home, leading those doing the fighting feeling that they were lacking in true purpose.  Added to this (and this is true of present day Afghanistan) the fractured nature of the fighting and the lack of a clearly defined front-line, meant that even when out of combat, true relaxation was never easy.

Perhaps because these issues were so widely known combined with the sense that a generation of America’s male youth had been badly let down by the system and the later high level of interest shown by the media, writers and film-makers (some of whom had served in the war), the Vietnam War is now viewed as something of a turning point in the recognition and treatment of war related mental disorders.

The term Post Traumatic Stress Disorder was created by the American Psychiatric Association (APA) in the 1970’s and listed in their (then current) Diagnostic and Statistical Manual of Mental Disorders 3 (DSM-III) at the behest and prompting of the Vietnam Veterans Against The War organization and their supporters.  PTSD is part of a larger categorization of mental disorders and while being far from exclusive to war veterans, it has provided psychiatrists, clinicians and general practitioners with a set of clearly defined set of symptoms that can be identified and possible cause can tracked against the patient’s history of traumatic events.  This has been of particular use when dealing with combat veterans.

The key factor in this is recognition of the symptoms and early treatment; a rape or assault victim may receive counseling as part of any criminal investigation and subsequent assistance program, in essence they will rightfully be expected to have been traumatized by their experience and hopefully any symptoms of PTSD will be picked up quickly and can be treated sympathetically. This kind of counseling, unfortunately, is rarely the case with returning combat troops in the U.K. at present.

The U.K. has lagged badly behind other Western countries in its approach to identifying PTSD symptoms amongst servicemen and women, there are no longer dedicated military hospitals in the U.K. and the facilities at Selly Oak Hospital in Birmingham are effectively (and rightly) dedicated to the treatment and initial rehabilitation of those physically wounded.  This means the onus falls on an often overworked chain of command and chaplaincy to recognize when servicemen and women are displaying any of the classic symptoms of PTSD. Turn around times between deployments is often rapid and those same men and women cannot easily be monitored when on leave.

Recognition of any potential problem becomes even more difficult upon a man or woman leaving the armed forces and the loss of security and new stresses and strains may often act as a trigger for any latent problems.  Unrecognized and untreated the outcome for PTSD sufferers and their families can be tragic; by 2007 more Falklands veterans had committed suicide than had been killed in the actual conflict. Divorce rates are higher than the national average for the same group and the high level of ex-servicemen amongst the homeless in the U.K. is perhaps indicative of the level of untreated mental illness.

Fortunately, there are charities in the U.K. which are leading the way in dealing with combat related PTSD for ex-servicemen and women, chief among them being Combat Stress.  These organizations provide assistance to PTSD sufferers, advice to general practitioners and support to partners and families.  Diagnosis and some basic Cognitive Behavioral Therapy (CBT) is often all it takes to help someone. Recognition that what they are experiencing in civilian life is not necessarily a result of their combat experiences is often the first step to stability for most.

As a result of a rising profile of combat related PTSD in the U.K. due in main to campaigning by ex-service groups and the likes of Combat Stress, some research into the condition is now being carried out at St Thomas’ Hospital in London.

In 2004, after some 17 years of keeping a lid on my own symptoms post-Navy, I finally sought out some counseling.  At the time, I doubt many people would have thought I had a problem but I was starting to recognize in myself some of the odd and at times, disturbing behavior I’d seen in some of my old Navy friends whenever we met up.  I was one of the lucky ones, my symptoms were (and occasionally are) pretty mild and I had the financial wherewithal to address the problems. Others aren’t so lucky.

I don’t think anyone comes through war unchanged, some less than others but providing help for those most affected by the wars, that our politicians send us to, is a lesson that this country and specifically its government needs to learn quickly.