The Long Boat Home – mental health and the ex-military

An open letter to therapists – an invitation for you to offer reduced cost therapy to ex-services men and women (here’s why its a good thing to do)

I am sixty this year and I write that, not simply because the fact still amazes me, but to indicate that I grew up in a very different Britain – austerity Britain, with its bombsites, Scouts huts, Church Parades and bucket & spade holidays on beaches spiked with barbed-wire and tank traps.

Clothes were rationed, women in utility wear, men in demob suits or a bouillabaisse of army surplus. The crowd going to a football match (Aston Villa) wore studded boots and marched in time for every mother’s son had been in the services.

Our parents and all our teachers had been in the services and as children we knew the reality of the quote “We sleep safely at night because rough men stand ready to visit violence on those who would harm us”[i]

It was plain obvious that war had consequences.  There were plenty of people for whom ‘life was not the same’. There were invalid newspaper salesmen, the greengrocer with ‘burns’ and Mr Evans in Wilmont’s hardware-store.  He had a hook where he once had a hand, (we were fascinated with that hook), and if you wanted the changes spelt out, you just had to take the number 11 bus to the Odeon New St, where a blind accordionist worked the queue. Shabbily resplendent in full campaign medals, he stood in front of a huge frame, full of pictures of himself as a handsome young boxer and then in the uniform of a Naval Rating.  He looked 60 – he may have been 30.

My father was demobbed late’46 and re-launched his legal career straight into the glut of no-contest divorces that peaked in 1947 as the new civilians re-united with wives they had not seen for 6 years..  At home we gave shelter to refugee ‘uncles and aunts;’ who would turn up and stay for a while until they became settled – each one more damaged than the last.  But I knew you did not have to be European to have problems.

My uncle, who commanded a tank in the desert campaign would lock himself away for days with a ‘migraine’, emerging only when the demons had settled.

Jack, an Australian, friend of my parents would drink too much and cause the odd scene, my father simply shrugged it off and said: “He was at Tobruk” and that was enough.  “He was at Tobruk” meant something like “of course he behaves like that’ he experienced Tobruk, and if you were there and did what he did and saw what he had to see, then you too would loose control”

For that generation war was a shared experience.

My mother had driven a ‘hospitality vehicle’.  What that meant was that when the bombings began she would get into the truck and drive into the mayhem to serve teas and sandwiches to the fireman.   At 19 she adored the responsibility, the excitement and flirting with firemen.  Later she would be haunted by visions of buildings collapsing and of a bus full of people – burning.  And we were a high functioning family – they may have been damaged but they were also resilient.

On the surface my father had avoided the physical and mental and relational scars that so many of his contemporaries still displayed.  Then at the age of 81 after a small car crash, that thin membrane that separates our conscious and unconscious materials split and his dreams filled with the corpses of men who had died some sixty years ago still bobbing on the shore at Normandy.

Psychiatry the enemy within

He never sought help for he had good reason to distrust ‘trick cyclists.  In 1940 he had was up for a commission and had only the psychiatric test to pass.  Things were going swimmingly until his interrogator asked a trick question.  “What do you think about when you masturbate?”  The trick, of course being that masturbation was certain signpost of neurosis and neurotics never make good officers or at least that was the theory.

In embarrassment and rebellion, he answered “Red Buses’.  That did it. In the kafuffle about his sanity he was lucky to remain a Sergeant Major, for what army wants a Welshman who engorges at the sight of a London Omnibus.

In the forces, psychology, psychiatry and psychology, (which although vastly different to ‘us’, are one and the same to ‘them’), have a singular purpose- the fighting effectiveness of the unity.  If you are in the military then ‘the psychs ‘are your enemy because their job is to turn you back towards the guns.

Writing about the military’s approach to psychiatry Freud stated:

“The therapeutic procedure…bore a stigma from the very first.  It did not aim at the patient’s recovery, or not in the first instance; it aimed above all at restoring his fitness for service. Here medicine was serving purposes foreign to its essence.  The physician himself was under military command and had his own personal dangers to fear – loss of seniority or a charge of neglecting duty – if he allowed himself to be led by considerations other than those prescribes for him. The insoluble conflict between the claims of humanity, which normally carried decisive weight for a physician and the demands of a national war are bound to confuse his activity”[ii]

The Point

To the ex-services community – seeking to work with a civilian therapist is a big deal.  We don’t often see these soldiers. We see their wives and their children in our clinics but they prefer to salve their wounds alone.  But perhaps it’s not up to them to come to us but rather it’s for us to make the move towards welcoming them home.

And here is where I would like your help.

The Long Boat Home is a cross-modality group of psychotherapists, counselling psychotherapists and counsellors who have volunteered to offer low-cost therapy sessions to ex-service men and women.  Whether you run an agency, or a private practice I am looking for unused and empty hours.

Some people have volunteered one session a week for two years – others have donated 6 sessions.  Each session counts but more importantly, the issue that really counts is that you put your name to this project.  You vote to welcome them home.

So far this month 17 men have been killed in Afghanistan.  This week alone there were 150 casualties 13 of whom had serious life-threatening injuries or suffered amputations. With 24-hour news we learn of deaths almost as soon as they happen, but the mental harm may not become apparent for many years.

If it is not spotted before you leave the forces then on average it takes 13 years for ex-service personnel to be diagnosed with PTSD[iii].  By that time we are no longer dealing with trauma.  What you get then is a personality that has accommodated itself to the wound.  If thirteen years after the event you were to wander into a hospital the diagnosis at that point is likely to be a ‘personality disorder’ which in most NHS clinics is shorthand for ‘this guy is really problematic and that there is little we can offer except medication.’

Of course if you break down in the field then the MOD will take responsibility for you but, if any issues emerge after you are ‘demobbed’ then – as a civilian your proper channel for help is the NHS. I am aware of just how the NHS is trying to embrace the talking cures, however it may take some years before the service is even adequate.

We are the only profession that is capable of healing these wounds and this issue is far too important to leave to government.

Every year 18,000 men and women leave the services.  Even if 20% of them have mental health issues the numbers are small.  There are more than enough qualified therapists in the UK to tackle this situation

In my experience the issues that are most important to ex-service men and women are the ordinary ones – relationship break-ups, difficulty in adapting to civilian live, depression, alienation, anxiety, sexuality (and the lack of it) feelings of estrangement, drink or substance abuse – these are the everyday, bread and butter issues of therapy, the combat stress related problems are relatively rare but they are exasperated by the lack of treatment available for the ordinary every day problems of trying to re-adjust to civilian life – especially at a time of high unemployment.

What we ask of you is time.  Volunteer and we will add your name to our database and prospective clients will contact you directly.  There is no pressure to take on anyone who contacts you – you must feel right with that client.  You will set your own fees. Many ex-service personnel are in good jobs and do not need subsidies, but they might and we have set a minimum fee per hour of £5. This is a reduced fee service not a free one and we do not want to see your generosity abused in anyway.

‘Not our kind of Victims’

This has proven to be a ‘Marmite’ kind of project – you either love it or hate it.

As a political group we therapists tend to be anti-military.  I understand that and I would like to emphasise that we are working here with civilians. We are not asking you to support a war but rather to follow the example set by those conscientious objectors who worked as stretcher-bearers.  We do not have to support the war to heal the wounded.

Today we have a professional army.  That means it’s an army of volunteers but most of those volunteers come from inner-city areas in which there are few job.  Many recruits simply want to get away from home. In the first and second world wars every one was in this together, but now it’s just the poor and a few adventurers. Many of these kids (I am sixty after all) were excluded from society long before they joined up.

When someone risks his or her life and watches their friends die they expect the sacrifice to make some difference.  Traditionally mobilisation for war was a time of collective transition. A gap opens up in historical time and a new vision emerges. Writing in 1914, the German feminist, Gurtude Bäumer commented that the first year of the war put the nation:

“…under a jurisdiction of an order other than the materialistic-technical one of the 19th century. An order which did not involve production pay profit and loss, cost and gain but life and death, blood and power”[iv]

This time there was no societal transition or new vision.  In 2001 they went to war and we did as President Bush requested – we kept shopping.

We have outsourced our own violence and just like men who use women and then call them ‘whores’, or homophobes, who disquieted by their own longings, go-‘queer-bashing’, we have taken to using the military and the police and then blaming them if the violence we have authorised is too violent.   But they did it all because we asked them to.

We have no idea of what new psychological syndromes will emerge from these present wars but we are in danger of re-creating the social situations that led to Post-Vietnam Syndrome – the name given to a disorder that a decade later would be called PTSD, an injury that occurs long after the even upon which it supposedly rests.

In way of explanation about what happened then and what is likely to happen now here is part of the testimony given by a disabled Veteran to a 1969 Senate hearing, the first to examine the quality of medical care that had been given to Vietnam Vets..

“To the devastating psychological effect of getting maimed, paralyzed, or in some way unable to re-enter American life as you left it , is the added psychological weight that it may not have been worth it, that the war may have been a cruel hoax, an American tragedy, that left a small minority of American males holding the bag. ….the inevitable psychological depression after injury, coupled with doubts that it may not have been worth it comes like a series of secondary explosions long after the excitement of the battlefield is behind, the reinforcement of your comrades in arms is a thing of the past and the individual is left alone with his injuries and his doubts.” [v]

Now, I was all for our intervention in Bosnia, vociferously against the war in Iraq and remain confused about what we are doing in Afghanistan, but the armed forces do not choose where they fight – parliament does.  It’s a democratic process. We can wave placards saying ‘Not in my name’ but it is “In our name”.  It really is.

If you would like to get involved please take a look at the website at www.thelongboathome.co.uk or email me at martin@thelongboathome.co.uk or call me on 07802338773.  I need your expertise, your advice and your help.  My intention is to build the site as a resource for both therapists and ex-service personnel.

I am flying this thing by the seat of my pants and it could fail but it could also be magical and that all depends on who gets involved.

There are some things worth fighting for.

[i] This quote has been attributed to George Orwell, and or Kipling. If you know where it comes from please email me.

[ii] S. Freud Memorandum on the Electrical Treatment of War Neurotics SE Vol 17, pp211-15. For the subject the relationship between the troops and the ‘psyches’ see also, Binneveld and Binneveld, 1998  ‘From Shell Shock to Combat Stress’ Amsterdam University Press and the excellent and highly readable Ben Shephard 2003 ‘A War of Nerves. Soldiers and Psychiatrists in the 20th Century’. Harvard University Press.

To learn more about the effects of stress on the human body and the problems of the PTSD diagnosis try Jones and Wessely 2005 Shell Shock to PTSD, Military Psychiatry from 1900 to the Gulf War. Maudsley Monograph 47, Psychology Press Hove.

[iii] This information came from a conversation that took place in January 2008 at the British Legion Headquarters between the myself and Lieutenant Colonel Peter Poole, M.B.E, Head of Welfare with the charity, ‘Combat Stress.’

[iv] Gurtrude Bäumer 1933 Lebensweg durch ein Zeitwende (Tubingen p280),  Cited, Eric Leeds , 1979 ‘No Man’s Land’, Combat and Identity in WW1, Cambridge University Press P16.

[v] Captain Max Cleland, testimony before the subcommittee on Veterans Affairs Senate Committee on Labor and Public Welfare Vol 6 January 1970, 270.  Captain Max Cleland was a signals corps officer the Ist Cavalry Division, who lost both legs and his right arm.  Despite his injuries he campaigned for better medial treatment for injured Vets. In January 1977 one of the first acts of Jimmy Carter’s presidency was to appoint Captain Cleland to being National Director of the Veterans Association.

Comments are closed.

From the Blog

Categories

Search