Who wants to hear about the psychological damage that war does to men?

Mike Payne works with people who are living with the hidden wounds of armed conflict. Here he explores the psychological damage that war does to men. 

As the country continues to mark the 100th anniversary of the First World War it seems we still tend to hear an edited version of events which fit only a narrow perspective, particularly around the psychological impacts on those who wore uniform.

So what exactly have we learned in 100 years?

The cluster of feelings and ‘stuff’ which goes with the personal aftermath of conflict is currently called ‘Post Traumatic Stress Disorder’ (PTSD). Increasingly there are calls for it to be called ‘Combat Related PTSD’, to recognise the specific nature of war and its impacts. A few years ago it was called ‘Combat Fatigue’ or ‘Combat Stress’, in the First World War ‘Shell Shock’, in earlier centuries ‘Soldiers Heart’, ‘Nostalgia’, ‘Homesickness’, ‘To Be Broken’. This has been going a while; the ancient Greeks were talking about it.

The impacts of war are cumulative 

In the UK PTSD is diagnosed for ‘individuals who have experienced a traumatic event’ whereas the impacts of war are normally cumulative, a series of events which build on top of each other. The NICE guidelines which define what treatments are available do not mention war trauma. The evidence of the treatments available for PTSD – CBT, EMDR alongside some drugs – show these help at crisis point but are less effective for long term recovery, even when available.

There is an assumption that soldiers are well cared for post service and injury. Support for physical injury is fantastic now, the early days in Iraq were not so good. As for psychological injury,  well here you hit a blind spot. It is OK to glorify the dead, to honour the physically injured, support wives and families – but those who cannot sleep for decades, whose red anger feels ready to explode at any moment, there seems an inability to fully look at this issue in the face.

We can’t blame men for not getting help

In the stage play ‘The Two Worlds of Charlie F’, which is about being injured in Afghan and acted by soldiers all whom have been injured, they joke about how good the support is. However the second half focuses on the emotional and psychological impacts, they certainly don’t joke about how good the support is there.

And when men don’t seek help frequently the blame is placed on them for not reaching out. True, no one can be helped unless they seek it. However how are men met when they do? And what effective support is available? What support is available from those who understand the complexities of our armed forces being consciously subservient to the democratic authority? Can they also handle the fact that there were no Weapons of Mass Destruction and deal with the question “so what was it all about anyway”?

It seems that those who live with the hidden wounds, those labeled with a mental health problem, are barely acknowledged and little understood.

Take the man who doesn’t talk about his experience in war. Don’t blame him for not talking, firstly understand that is part of the trauma and more importantly that this goes way deeper than just ‘a mental health problem’.

Not all of you comes back at once

One quote which stood out in ‘The Two worlds of Charlie F’ was “Not all of you comes back at the same time”. Understanding that is a great start point.

And if he really told you, when words are not enough, could you handle it?

How can that voice be heard today?

Here is a suggestion. A picture of Wilfred Owen hung on the wall of my Regiment’s Officers’ Mess, my home as a young man. How about we create the space for the soldier’s voice to be heard now from this generation, just as the war poets did for theirs.