Combat Stress The Commonwealth Experience

Copp Combat Stress.indd 3 10/6/2009 12:53:29 PM 1 : Combat Stress The Commonwealth Experience Published by Scholars Commons @ Laurier, 2009 4 the scope of the proposed project would require external funding and time release from the classroom but the guardians of the medical history field were not impressed. An historian without credentials in medicine, psychiatry or psychology was not acceptable as the principal investigator for such a project so I returned to the study of operational matters while maintaining an interest in the area. I tell this story because the literature on combat stress and PTSD is largely the work of professional psychiatrists and psychologists who are pursuing specific methodological or research agendas. There is nothing surprising in this but since the research agendas frequently conflict it is important to determine which studies are evidence-based. For example my files include material on a wide range of treatments for PTSD including craniosacral therapy, yoga, a “virtual Iraq” simulation using a modified X-box “Full Spectrum Warrior” game and many others. Positive results reported are largely due to the placebo effect and are reminiscent of earlier enthusiasm for faradism (the employment of an electrically-charged wire brush) insulin sub-coma therapy, LSD, hypnosis, de-patterning and many other abandoned treatment methods. Perhaps an historian’s overview can be of some value. Let us begin with a thesis statement. The argument of this paper is that throughout the 20th and 21st centuries psychiatrists and psychologists have sought to diagnose and treat war-related trauma by applying the intellectual and social constructs current in their profession. Whether derived from Freudian and other psychodynamic theories or physiological approaches, the concepts employed have rarely been evidence-based. Anecdotes and famous case studies have underpinned most psychiatric research. One of the major sources of confusion in current discussions of operational stress injuries is the problem of distinguishing between acute stress casualties on the battlefield and delayed responses including PTSD. In the First and Second World Wars, casualty clearing stations were overwhelmed with individuals who had broken down under intense combat conditions. During the Great War many if not most of these breakdowns were characterized by “hysteria,” including paralysis of limbs, speech or other functions. Such reactions largely disappeared in the Second World War to be replaced by withdrawal, trembling and pronounced startle reactions. Individuals appear to have unconsciously displayed symptoms of sufficient intensity to achieve primary gain – immediate relief from the stressful situation in ways acceptable to psychiatrists of the era.4 During the Korean and especially the Vietnam War the incidence of acute reactions to combat declined dramatically. Many explanations for this remarkable situation have been put forward with some consensus that the one-year rotation policy was critical in maintaining the soldiers will to keep it together for the balance of his tour. During the period when I was more actively involved in this research British military psychiatrists dealing with the Falklands, Northern Ireland and Balkan deployments were confident that the selection, training and treatment methods The stress of battle clearly shows on the face of a Canadian infantryman as he has his physical wounds attended to during the harsh fighting in the Scheldt Estuary, October 1944. Li br ar y an d Ar ch iv es C an ad a PA 1 31 26 0 Copp Combat Stress.indd 4 10/6/2009 12:53:30 PM 2 Canadian Military History, Vol. 18 [2009], Iss. 3, Art. 2 http://scholars.wlu.ca/cmh/vol18/iss3/2 5 employed in the British Army had reduced “battleshock” to a minimum. Furthermore in the words of Brigadier Abraham, who took me to task in the British Army Review for suggesting otherwise, “exhaustion or shock need only be temporary and it is up to everyone from junior commanders to doctors to see that it is so.”5 Unfortunately what real ly appears to have happened is that a different way of manifesting the symptoms of stress similar to those which had lead to the diagnosis of Post-Vietnam Syndrome and eventually PTSD had emerged in the United Kingdom. The British Ministry of Defence (MOD) was quite unprepared for the situation having insisted that through the application of the classic principles of forward psychiatry – proximity, immediacy and expectancy – the rate of full recovery would be very high. If a chronic neurosis developed it was due to pre-enlistment genetic or developmental factors. PTSD was viewed as a result of the particular circumstances of the Vietnam War, a conscript army and a peculiarly American reaction to the conflict. When more than 2,000 British veterans joined a class action suit originally brought by survivors of incidents in the Falklands, the High Court of England and Wales accepted the explanations of the MOD and denied the claimants’ argument that the army had failed to provide adequate measures of prevention, detection and treatment for PTSD.6 The High Court judge, Mr. Justice Owens, did recognize that by 2003 when his judgment was rendered, PTSD had become widely recognized placing a new burden on the MOD but, he noted, this was not the case in 1980. He also recognized that: the ultimate function of the military is to fight and win in battle. This meant that there will always be a necessary culture of toughness. It is a culture of mutual dependence in which the interests of the individual are subordinated to those of the

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