Is it time we stopped using PTSD as a cover-all diagnosis for the psychological difficulties faced by veterans?


There is a current train of thought within mental health care that the use of PTSD as a cover-all diagnosis for the psychological difficulties faced by veterans should be re-evaluated. Some mental health experts have proposed the existence of a separate condition known as ‘moral injury’, which is marked by a slightly different set of symptoms and different causal triggers. The term ‘moral injury’ is a new term but it's an old concept. It’s a term that few like to use in the military because it implies wrongdoing. From the philosopher's perspective, the concept is a way of talking about anguish caused by wrongdoing (real and perceived).

But transgression isn't the only issue at the heart of moral injury. So is the perception of falling short in combat, that you failed in some way and perhaps your shortcomings cost lives. This in turn brings guilt, the guilt that you survived when others didn’t. The result may be shame, and all too often suicidal shame.

Moral injury is said to be distinct from post-traumatic stress disorder, which is generally thought of narrowly as a fear-conditioned syndrome marked by hyper-vigilance and flashbacks. The prevailing treatment for PTSD is therapy to “decondition” the fear response. But guilt, shame, raging resentment, and betrayal are different from fear and, it is argued, require a different approach. By using moral philosophy, it is suggested that we can understand the evaluative content of emotions such as guilt and shame – common occurrences in the proposed diagnosis of moral injury – and therefore provide more effective treatment.

It’s an interesting argument and pertinent to the story in ‘A Life Before’ which touches on PTSD and the concept of moral injury.  

Thirty three years on and we’re back to square one. We owe it to those who lost their lives in the 1982 South Atlantic conflict to find a way forward, not start another war

 
As a kid in the late 1970s I idolised footballer Ossie Ardiles - a hero of the 1978 World Cup winning Argentina team. I remember his first appearance on British soil, taking to the pitch to a Buenos Aires style tickertape welcome in front of 48,000 boisterous fans. Football was my passion and Ossie was my inspiration - a huge poster of the enigmatic Argentinian enjoyed pride of place on my bedroom wall. Then, in 1982, having just completed my army basic training, war broke out between Britain and Argentina and I found myself on the opposite side to my footballing hero’s cousin, a young air-force lieutenant called José Ardiles. It was a war that took the young lieutenant’s life. It was a war that saw 17-year-old British soldiers pitched into trench warfare, fighting with bayonets, knives and even bare hands; bitter ‘gutter fighting’ that had more in common with a medieval brawl than a twentieth century conflict. It all seemed absurd. It still does.
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For those who fought in the conflict there were no winners and losers – both sides exposed to war’s long-lasting and sometimes life-changing effects. What did it achieve? For a start it helped bring down a ruthless dictatorship: some 12,000 people are officially listed as having been murdered by the regime that ruled Argentina from 1976 to 1983 and thousands more are still among the ‘disappeared’. Following the fall of the Galtieri regime after the 1982 conflict, successive Argentine governments recognised the importance of the friendship with an old ally and, without formally revoking their claim on the disputed Falkland islands/Las islas Malvinas, Argentina got on with improving relations, both with the islanders and with the UK. Reconciliation was swift. Argentine visitors returned to the islands, accords were signed on fisheries and oil exploration and, by 1994, Argentine and British soldiers were serving together in Cyprus. Argentina and Britain had enjoyed 150 years of excellent relations and ten weeks of war. It was only natural that things should get back to the way they were. In the mid-nineties there was plenty of optimism that a permanent solution to the sovereignty dispute would be found, a fitting tribute to all those who lost their lives in the 1982 conflict. They didn’t die in vain: peace would be their legacy.
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Thirty three years on and that legacy is under threat. Britain is set to deploy extra Chinook helicopters and a new surface-to-air missile system to the Falkland Islands, amid fears Russia could be arming the Argentine government. We hear the same sabre-rattling rhetoric that preceded the hostilities three decades ago. And there’s the same political deadlock. As long as the issue remains a potential source of political capital in both Argentina and Britain, a mutually acceptable negotiated agreement seems unlikely.
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The hardline approach taken by the British government towards any negotiation on sovereignty is fuelled by the fact that the 1982 conflict cost 255 British lives, as well as the lives of three islanders, with many more bearing the scars of war – physical and psychological. It’s a rigid stance matched by Buenos Aires (649 Argentines losing their lives in the war). It’s a bitter irony that the 1982 war, far from helping resolve the matter, has only served to complicate the issue further. There are strong and passionate sovereignty arguments on both sides, and, of course, the islanders have a right to be considered. But such rights have rarely taken precedence over political reality in post-colonial clean-ups. When Diego Garcia was handed over to the US in 1973, the residents were relocated without any consultation on self-determination. However, self-determination, the basis for which Britain rejects talks on sovereignty on the Falkland Islands, might well be the key to progress not the obstacle; Argentina should be looking to win the islanders over, forging links with them instead of isolating them. Any growth in the Falklands economy, whether through oil, tourism or fisheries, ought to have a knock-on benefit for its neighbour.
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When the crisis in the South Atlantic erupted in 1982, most British people had to reach for an atlas. It was the military intervention that put the Falkland Islands on the map. Had Argentina stayed on its original path of establishing relations with the islanders and conducting low-level sovereignty talks with London instead of initiating military action, it’s quite possible there would have been an agreement by now and the Falkland Islands would be as hard to pick out on a map as Diego Garcia.
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The human cost of the 1982 conflict should not be allowed to become a further obstacle to a peaceful solution. The far-reaching effects of war have touched the lives of many ordinary Argentines in the same way they have affected many British families. For Argentine veterans there is also a sense of injustice as well dealing with the aftermath of the war. It's perhaps why the islands have come to mean so much more to the people of Argentina. They need to know their loved ones didn't die for nothing. Only when the issue is resolved can we say that all those who perished in the 1982 conflict didn't die in vain. We owe it to those who lost their lives in the fighting (not to mention those who returned from the war but still suffer the consequences) to find a way forward, not start another war. We owe them that much.

Rambo and the Real-Life Struggle with PTSD: The portrayal of PTSD in fiction and the stigma attached to mental health


Even if you haven’t seen any of the films, the name Rambo will mean something. Rambo is a term that has become synonymous with gung-ho action, owing to the fictitious character’s capability of carrying out extreme violence either in war or because of war. Interestingly, First Blood, the movie that spawned the Rambo franchise, is based on the anti-war novel by David Morrell, a powerful study of how war can affect the mind and the sometimes longer-lasting effects.

Combat related stress is nothing new, diagnosed as ‘shell shock’ in the Great War and documented as far back as Ancient Greece in Homer’s epic poem, Odyssey, in the aftermath of the Trojan war. The term PTSD, however, didn’t exist when David Morrell started his novel in 1968. At the time, American psychiatrists were just beginning to get to grips with a combat related condition that they recognized was becoming more frequent and more acute in returning service personnel from Vietnam. The dynamic in Morrell’s book is altered for the film version to accommodate a wider audience. Fair enough, I suppose, but it’s just another example of how contemporary fiction, whether portrayed in books or on screen, uses PTSD for dramatic effect while ignoring the underlying issues. It’s visual and adds to the drama. Symptoms like violent outbursts can enhance a scene while a flashback serves as a valuable tool for plot development. But there’s usually little or no reference in the narrative to the condition itself. A useful prop bereft of any psychological analysis.

The oppressing effect war can have on the mind was captured in the poetry of Wilfred Owen. Owen suffered shell shock fighting in the Battle of the Somme and the nightmares that he experienced afterwards had a major influence in his writing. Owen found a way to articulate his war experience, not what happened but how he felt about it, like in the poem Strange Meeting, a haunting insight into the psychological impact of warfare. But many who suffer a traumatizing event, men in particular, find it difficult to express their feelings. There’s still a lot of stigma around PTSD, especially among veterans. It’s something rarely discussed in macho environments and it’s something Hollywood often glosses over. A common theme with mental health problems in fiction is that the drama is in the crisis and not in the treatment. PTSD symptoms are viewed almost like personality traits, advancing the plot but rarely explored. Rambo, on the big screen at least, is largely portrayed as an out-of-control killing machine, his psychological imbalance seen as just part of his character. But it’s important to point out that PTSD is very amenable to therapy. Focusing solely on the “sensational” lowlights comes at the expense of highlighting the whole PTSD journey including the treatment. Most veterans resolve their symptoms by seeking counselling. Just talking about it can help.

The Rambo franchise has been built on the effect war has had on one man.  But there are no Rambos in war, just human beings made of flesh and bone who can be destroyed by what they experience in combat as much as by the bullets and bombs they face on the battlefield. The road to recovery is just as important as the destruction and orgy of chaos that fiction often throws up.  

 

 
 

WW1 Centenary should be an occasion for remembrance of loss of life and national reflection

 
The WW1 centenary should be an occasion for remembrance of loss of life and national reflection, not political point scoring. Politicians wading into the argument over the Great War over the last few days reminds us that the politics of war remain as far apart as ever from the reality of war.
Politicians are the ones who start wars but are not the ones who fight them. The involvement doesn’t end there though; victory or defeat in war often defines a politician’s career. But there are no winners or losers on the battlefield. The long lasting consequences of war affect both sides and extend far beyond the day the war ends.
In this extract from ‘I am the Enemy’ a young soldier is writing a letter to his wife from the trenches in 1916.
‘As I sit here now, hearing the chatter of men with families back home just like me, I can’t help think of the prime minister’s words about not sheathing the sword until the enemy is crushed. It’s all very well for these fellows back home in the comfort of their houses and surrounded by their families to talk in such a manner, but when you are out here, believe me, it’s sometimes hard to hate a man who is just like you. You hate the mud and the cold, wet, miserable existence but not the chap on the other side.’
Military force is essential for a country’s security and service personnel can’t pick and choose which wars they fight in, otherwise it just wouldn’t work. We have to trust in our democratically elected politicians to protect our interests and preserve our national security. But in this centenary year, as we mark the beginning of a conflict that killed millions, let us reflect on the human cost, not the politics.

 
 

Don’t Judge a Book by its Cover: Sometimes it’s worth looking beyond the cover to see what a book is really about.


Don’t judge a book by its cover. Isn’t that what they say? Well, whoever ‘they’ might be, they just happen to be right. There’s often far more beyond the cover, or the title come to that. I’ve just read a book titled ‘We Bought a Zoo’. At first glance you would think this is essentially a story about doing something out of the ordinary, taking a chance, following a dream. And it is, mostly. However, a closer analysis of the narrative suggests that this is also a story about losing someone you love and how you cope with the loss.

I mention this because ‘I am the Enemy You Killed, My Friend’ is very much in the ‘Don’t judge a book by its cover’ category. Just like the zoo story, it’s also about losing a loved one and coping with the loss. So why does it have what might appear to a misleading title? The answer is simple. Like many books, there are many elements to the story; the title is derived from one element of the story that links the other themes.

In this changing world of book publishing where the reader is exposed to a far greater number of books, judging a book by its cover has never – it might appear – been more relevant. Not only are there more books, there is an increasing number of new publishers and debut novelists vying for the reader’s attention and the cover provides the first screening option. One glance at a cover is very often enough to determine whether you flip the book over and take a look at the blurb or put it back on the shelf.  But sometimes it’s worth looking beyond the cover to see what the book is really about.

Two classic 80s Christmas hits that share a message that isn't really about Christmas


When it comes to the sound of festive tunes competing on the airwaves, Paul McCartney’s Pipes of Peace and Jona Lewie’s Stop the Cavalry are perennial Christmas favourites. They are songs we have come to associate with Christmas and think of as Christmas tracks.

The message in both songs is something different. Stop the Cavalry, set at the Front during the Great War, features a soldier missing his girlfriend. The only link to Christmas is the line in the song: 'Wish I was at home for Christmas'. This was picked up by the record company and, with the addition of a tubular bell, the track was marketed as a Christmas song. The video for Pipes of Peace was a great piece of film to go with one of McCartney’s lesser known hits. The video depicts the famous 1914 Christmas truce between British, French and German troops. It portrays a British and a German soldier who meet up in No Man's Land and exchange photos of their loved ones while other soldiers fraternise and play football. When a shell blast forces the two sides to retreat to their own trenches both men realise that they still have each other's pictures.

With the anniversary of the beginning of the Great War approaching, Pipes of Peace conveys a powerful and poignant message, encapsulating perfectly the human aspect of that war. If you hear the song over Christmas, listen to the lyrics. Better still, take a few minutes to watch the video clip.

Argentine singer-songwriter Sergio Denis recorded a Spanish version of Pipes of Peace re-titled Pipas de la paz on his album La Humanidad (1984).

One For Sorrow, Two For Joy. Counting Magpies: What does it all mean?


“You’d think a cemetery would be a quiet place, a place for reflection. Not with these magpies around. This morning they’re making more noise than ever.” These are the opening lines from ‘I am the Enemy’ and it’s from this Victorian cemetery, amongst the squabbling magpies, where Chris, the narrator, recounts his physical and psychological journey through life. The fighting magpies in the cemetery are a feature in the book as Chris ponders the significance of their feud as well as their number. He remembers his father telling him that the symbolic meanings of the magpie rhyme were a load of old nonsense but that didn’t stop his father from reciting the line from the rhyme that related to the appropriate number each time he came across the flutter of the distinctive black and white wings.

This is what author Barnaby Rogerson says on the subject in his book The Meaning of Numbers. ’It is tempting to see the counting of magpies, and the chanting of verses about what the number of birds might mean, as a tenuous but still active strand of traditional lore that links us directly to the ancient art of divination by watching the flight of birds. We know that priests throughout the ancient world attempted to read the future by watching the passage of birds pass some sacred feature, such as a temple sanctuary, a headland or the gates of a city. The direction of their flight, their species, their number, the month, the hour and the shape of the flocks must all have had a significance that is now lost to us. One has only to think of the shapes formed by starlings at dusk, the vast squadrons of migrating geese or gulls returning every night to the sea, to touch upon the complexities of this art, let alone what the chance sighting of an erratic bird might mean.

The counting of magpies encountered on an English pathway drops us into a more homely version of this lost science, concerned with the fate of an immediate family. As with any ancient oral tradition, there is a considerable variety after the first two lines. The most popular version in use today stops at seven. It is also worth noting that the magpie is a meat-eating corvid, and that the British have always tended to weave gloomy references around magpies and their bigger cousins, such as crows and most especially the raven. All these birds would have been seen to feed off the dead of the battlefield, or those left swinging on the gallows, exhibited on the gibbet or impaled on a pike.’

Folklore, superstition, call it what you like, the magpie still has the power to make us pause for thought.