‘Post-repatriation stress disorder’?

I have been involved in repatriations of bodies since working with victims of torture in the 1980s after their missing relatives' and friends' bodies were discovered and had to be brought home. I also experienced repatriations working with the NYPD after 9/11, and with the British armed forces at 27 military bases from 2007 to 2014. I have observed a distinct pattern of psychological reactions to repatriations.

Repatriations are highly important solemn ceremonies, and most individuals who take part in them experience a range of reactions. Until repatriations are researched, reactions to them are most easily contained, understood and managed under the umbrella term 'post-repatriation stress disorder' (PRSD).

PRSD is 'an inconvenient truth' (see Nimenko, 2015) and is not mentioned in literature searches or by those involved in ensuring repatriations take place. Without researching repatriations, the impact of PRSD on individuals cannot be accurately described and PRSD cannot reliably identified as a separate disorder.

Repatriations let us experience sacrifice and loss side by side with the justice and injustice of conflict. This unique mixture gives them the potency to be profoundly stressful and overwhelming, and also life-changing. Repatriations are also 'invisible bullets' because their impact is hidden, leaving individuals being poorly understood and often suffering in silence just to try and keep their jobs. This can ultimately lead to operationally non-effective individuals and can result in future claims for compensation.

Individuals are frequently left permanently haunted by repatriations because they have the power to be profoundly moving and life-changing experiences (see BBC News Channel: tinyurl.com/nh83p55). Repatriations can either reinforce or weaken our 'sense of meaning' of ourselves and society, our 'world view'. This can have profound impact because it can change religious views, belief in society, leaders, justice and injustice. Repatriations can change someone's whole direction in life, affecting their career, relationships with family, friends, colleagues and the wider world.

PRSD is an 'elephant in the room' for several reasons. First, most GPs and psychiatrists working with the armed forces and emergency services are reluctant to accept PRSD as an identifiable disorder, but at the same time indicate that they do not want to have to consider another line-of-duty-related psychological disorder which they would have to look for; especially when a person leaves. Second, they admit they haven't got the staff to prevent it, screen for it or treat it, let alone the money to compensate for it. Third, there is also an unspoken, culturally conditioned expectation of not showing emotional reactions to repatriations. The rigorous training of the armed and emergency services strongly encourages individuals in rapid recovery and the need to immediately execute other duties after repatriations. This does not necessarily add to resilience training and may actually encourage avoidance.

Lastly, there is a taboo of speaking about death in general but especially about repatriations because the media portrayal of repatriations plays a role in nurturing the continued support of the public for the emergency services and armed forces. Just talking about repatriations can be the beginning of reducing the risk of developing reactions, especially if the need for psychological training, monitoring and support is recognised.
Wasyl Nimenko
Berkeley, Gloucestershire

Reference
Nimenko, W. (2015, Spring). Post-repatriation stress disorder: An inconvenient truth. The Psychotherapist. Issue 59, pp.37–39. Available at http://issuu.com/ukcp_commsmgr/docs/tp_59_v12__final_