Beyond the mythology of war

First up, Jon Sutton reports on a pair of opening keynotes at the Society's Annual Conference in Birmingham

Launching into his opening keynote as a 'fully paid-up member of the Society for the Abolition of PowerPoint', Professor Sir Simon Wessely delivered an erudite and thought-provoking talk on 'what has forward psychiatry in wartime achieved'.

Wessely took aim at the 'mythologising' of the First World War, hoping to move away from the influence of Oh! What a Lovely War… and its depiction in the comedy series Blackadder. He also called for one day a year when we should respect a truce, not talking about the war: 'maybe Christmas Day… have a game of football instead… it's a good idea, don't you think, not been tried before'.

Winding the clock back to 1922 and the work of the Shell-shock Commission, Wessely showed that people were well aware there was a big problem. War created psychiatric casualties by the thousands, and there were five massive shell shock hospitals in France. Why had it become such an epidemic? Psychologist C.S. Myers refused to give evidence to the commission (starting, the new President of the Royal College of Psychiatrists joked, 'a long tradition of not listening to psychology'). Some subscribed to the view that shell shock was the result of conditions that were 'more than the mind, body and soul could bear'; others felt that some men just weren't made of the right stuff, with Lord Gort VC famously saying that 'breakdown in battle is a regrettable weakness… it does not happen in good units'. Others disparaged shell shock sufferers as 'feminine', describing the physical characteristics which gave them away.

Whatever the cause, it was clear shell shock was 'not a wound like any other'. The reaction was 'forward psychiatry', considering the role of proximity, immediacy and expectancy in combat stress. Yet the role of psychology, Wessely said, was actually pretty limited: treatment consisted of a couple of nights rest, clean clothes, food, exhortations to 'be a man' and 'do your duty'. This approach was social more than psychological, as also revealed by the fact that it appeared important to keep men in uniform and close to their mates.

Fast-forward to the Second World War where there was a restatement of Victorian values of 'character'. The UK policy was that nobody was allowed to leave the military due to psychiatric breakdown, there would be no pension, and no diagnosis should suggest a link between the mind and body. Despite this harsh policy, against which voices were quickly raised, forward psychiatry became standard doctrine, and the arrival of the Americans brought an emphasis on collecting statistics and also an interest in studying motivation. It was eventually realised that men fought for each other rather than love of country, and every man – even those who possessed the 'right stuff' – had his breaking point.

In Vietnam, the US were determined not to overlook the lessons of the past and so they implemented the 'DEROS' policy: date expected for return from overseas, where service was one year only. The authorities claimed 'we have achieved our greatest victory ever in preserving the fighting strength', but this came at a cost: Wessely explained that many soldiers never really bonded with their comrades, and there was a 'curious reversion of soldiering tradition' with many only finding a 'military' identity and bonding with comrades after the conflict in the form of the 'traumatised veteran'. The new diagnosis of PTSD was 'rushed through in an amazingly short time', Wessely said, put together 'literally on the back of an envelope'. PTSD was the first acknowledgement that not just acute but long-term disorders could be the result of war.

Now, staggeringly, 90 per cent of people think that those who serve in armed conflict are very likely to come home physically or mentally wounded – trauma is expected. In fact, the biggest threat to the well-being of the armed forces is alcohol, violence and violent behaviour. Giving the example of his own father, who served in the Navy in the Second World War and was one of only 17 survivors of a sunk ship, Wessely guarded against a simplistic view of our 'veterans'. They do not all see themselves as 'heroes', or victims. They need feelings of understanding, not pity, Wessely concluded. We should see them for what they are, not what we think they should be.

Historian Ben Shephard took to the stage next, to discuss how psychology was 'sold' to the military'. It was, he said, a tall order to do justice to the many-sided relationship between psychology and the military. 'I'm just a writer, and these are short fragments from a vast uncompleted film'.

Shephard began in 1937, with Frederick Bartlett writing for RAF Quarterly on what psychology could do for the military. He was, Shephard said, a 'wary, canny operator'. Unlike Myers, who had tried to expand from brass-plated experimental psychology, Bartlett was determined to give Cambridge the kind of psychology it wanted. He offered to reduce fall-out in pilot training, to deliver aptitude training, to apply research in fatigue and to reduce the horrendous incidence of accidents. But he was careful not to go too far, couching his discussion of 'character' in terms such as 'an honest psychologist must regretfully admit that there are at present no secure methods for its study which are within sight of a practical application.' It took the arrival of the 'young genius' Kenneth Craik to offer more in the way of 'exact and illuminating measurement'.

Did psychology deliver? It did make some difference, according to Shephard, but not as quickly or as dramatically as Bartlett had imagined. Projects were limited to problems such as improving the escape hatch on the Lancaster bomber (likened to 'birth trauma' by those having to exit it); Bartlett's sales pitch largely comprised a narrow psychology of the natural senses.

By contrast, psychologists in Germany embraced issues such as character, and psychology became established as a separate discipline there largely due to extensive involvement with the military. Shephard described the three-day assessment centres for officers whereby character was diagnosed from facial expressions of eyes and mouth: 'weaknesses of various kinds may lurk in a flabby lip'. It is not possible to fully establish what contribution psychology made to the German army and the Holocaust, but as just one example it is thought it helped to pioneer 'leaderless groups'. Like Wessely, Shephard referred to the 'fundamental shift in values' that the dawning of the PTSD diagnosis heralded. Until then, the assumption was that with decent leadership and social support, anyone could get through even the most traumatic of experiences. PTSD, Shephard argued, was a political diagnosis and developed in a' cart before the horse fashion': the concept was documented, a theoretical model added, and only then was it studied. But eventually psychiatrists began shifting their ground towards resilience, with the US Department of Defense spending $140 million on a preventative programme organised by psychologist Martin Seligman.

Research suggesting just 22 per cent of cadets believed they most likely would not develop PTSD on future deployment showed a clear need for what was described as 'the largest deliberate psychological intervention in history', with online self-assessment, self-help and access to specialist resilience trainers. Yet Shephard argues that the programme has only demonstrated an ability to indoctrinate soldiers: there is no evidence that it increases resilience. Seligman invokes the past of American psychology in figures such as Yerkes, Shephard says, co-opting an agenda which was actually about race and intelligence. 'It's a classic example of "huckstering", using what's on the shelf', Shephard concluded. 'It's a mechanistic view… culture matters more than psychologists are prepared to admit.'

Facilitating the discussion was Kate Adie, former BBC chief news correspondent. She has spent time alongside the military but by her own admission is 'in no way a soldier', despite spending time as 'one woman amongst 43,000 men in forward areas'. Reporting from environments as diverse as conflict, Crufts and cricket was important to Adie: 'If you've forgotten what normal is, you can't convey the abnormal'. Judging the tone of coverage can be tricky, she said: 'You don't want to give people fear, a ghastly shock… you risk stopping people coming back… but you have to deliver enough emphasis on the abnormality, the violence and unfairness of war.'

War journalism is considered sexy, Adie said, yet many who ask her about how she has been damaged by her experiences have no understanding of war. 'They ask me when I became desensitised to atrocities… I have to convince students that sheer practicalities in difficult circumstances fill your waking moments. You don't walk around the place in conflict musing on how your inner person is faring… it just doesn't happen.'

People have become convinced that the personal emotional is everything, Adie argued. 'A great deal of modern journalism is influenced by "What do you feel about…?".' Yet if you look back at historical accounts, of several thousand women who experienced war directly on the front line and many more who worked in tough conditions in munitions factories, mental health was never questioned. Instead, you find 'stories of determined women… they were not the subject of worried letters and diaries saying "I feel myself coming apart".' They were, however, always moved by the plight of the men. 'I think they would be utterly staggered if we had asked "How do you feel?",' Adie concluded. 'Maybe we have changed.' 

The untold stories of conflict

Whilst research abounds on the experiences of armed forces personnel, this can paint an incomplete picture of the everyday reality of war. This symposium, chaired by Kate Bullen (Aberystwyth University) and convened by Eric Drogin (Harvard Medical School), explored this less-trodden path of the hidden elements of conflict, and their contributions to our views of wars past and present.

Drogin began by presenting on behalf of Gareth Hall (Aberystwyth University), whose work addressed the expanding roles of women in war and the effects of their participation on gender-role stereotypes. Despite historic accounts of women participating in wartime industry, the roles of women can be overlooked in favour of regarding masculinity as a military ideal. However, the increasing numbers of women joining the armed forces raises the question of how women identify with their gender within a largely male environment. An analysis of modern war poetry exposed the different experiences of serving men and women, with men often expressing loss, and women feeling a need to mask their emotions. The research showed that wartime gender roles are not merely 'masculine' versus 'feminine', thus challenging society's view of gender norms, and questioning whether bringing women onto the front line truly increases sex equality, or merely places different constraints on women.

Next, John Williams, from Aberystwyth University, reflected on the impact of conflict on older women.This group are at greater risk overall, but their specific needs often go unrealised. Particular problems included resisting displacement – either through being unaware of government services or inability to travel – and being last to access dwindling relief supplies.

A high incidence of PTSD on this group was linked to poor conditions in refugee camps and loss of status within a family. Williams called for humanitarian initiatives to examine and attend to the individual needs of this group, to acknowledge that this group are not exempt from sexual violence, and to recognise the contributions they can make, such as caring for children.

Carol Spaderna (University of Derby) reviewed strategies to maintain the relationships of couples separated by war. Although research has been conducted on supporting armed forces personnel, and partners remaining at home, little has been done to address the toll taken on their relationship. Although loneliness and fear for a partner's safety can be problematic, creating lasting memories before deployment and involving family and friends were reported to be helpful strategies. Preparing for homecoming was also imperative, as both partners would need to adjust to particular events or changes in routine that had occurred since parting. This was especially important if the couple had become parents during separation. Early detection of any barriers to normality could help to tackle underlying stressors. Finally,  it was considered important to maintain a healthy lifestyle, and to keep a strong perspective of the situation.

For the final paper, Eric Drogin returned to discuss the ways in which wartime propaganda has been created and delivered for maximum effect, and the ethical implications of its use and study. The emotional reaction caused by propaganda can have unintended consequences, as anti-German propaganda used during WWI often documented fictitious atrocities, and may have caused Hitler's actions, years later, to seem less believable. The alleged source can also be manipulative in several ways. Whilst 'white' propaganda discloses its true source, 'black' propaganda is designed to appear as though it was produced by its intended target group, widening the scope for influence. Crucially, ethics codes state that psychological knowledge must be generated for beneficial purposes. However, propaganda can range from the arguably beneficial (such as public health campaigns and preserving morale) to the harmful, and increasing understanding of its workings can be used to either end, leaving psychologists studying the phenomenon balancing on a knife edge. LT

See the edition PDF version for full conference reports.