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Britain’s top military psychiatrist thinks treating soldiers as heroes or victims does not help them, he tells Joe Shute
Prof Sir Simon Wessely grew up well aware of what combat could do to a person. His father, a Jewish child refugee on the Kindertransport from Nazi Germany, signed up to fight for his adoptive Britain as soon as he turned 18 and served with the Royal Navy in the Second World War.
Rudolph (known as Rudy) was fluent in German, so he worked intercepting communications from the U-boats. Wessely admits, though: “My father didn’t have a good war.
“He was sunk twice. Once was terrible (in the North Sea) and he was one of only a few survivors. He had nightmares all his life about that: the sound of people drowning.”
Sitting opposite Wessely in his office at the Royal College of Psychiatrists, of which he is president, it is tempting to lapse into a pseudodiagnosis about the influence of his father’s night terrors on his own career choice. He is, after all, now Britain’s leading expert in military psychiatry.
For the past 20 years he has advised the Armed Forces on the impact of combat on the mental health of its participants, from the Gulf war to Afghanistan. He is also co-director of the King’s Centre for Military Health Research.
Yet he dismisses this theory with a firm shake of his magnificently balding pate, the remaining hairs on top wispy and waving like the last river rushes in autumn.
“My father was the least military person you could imagine,” he says, insisting he managed to lead a happy life in spite of the trauma; marrying, working as a teacher and living in the Sheffield suburb of Nether Edge. Rudy Wessely died in 2013, aged 88.
“He was different but he was fine. War didn’t define him and he didn’t need help – although he was stubborn as a mule. His experiences had changed him but not in a pathological sort of way.”
As a nation, Wessely says, we have fallen into a dangerous trap over discussions about veterans and their mental health. He believes the debate has become distorted to the point where it is having a worrying effect on how we treat and assess the trauma of war.
“We have a very skewed view of the Armed Forces now,” he explains. “Because we no longer have National Service most people like me don’t know anyone in the military [so] we have this image which is really unhelpful. We either see them as heroes or victims – neither of which they like.
“We can’t really manage to see them as normal people doing a difficult job – for them, the real accolade is to be a professional. We’re losing the plot on that and being unrealistic. Our aim is to remove the pity.”
Aside from his clinical and research work, the 59-year-old Wessely (who was knighted in 2013) is a trustee of Combat Stress. The charity is part of Contact, a collaboration of leading military charities, NHS and military experts, and one of eight mental health organisations that comprise the Heads Together campaign, launched by the Duke and Duchess of Cambridge and Prince Harry this year. The
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The point of Contact is to simplify the mental health support options for serving and retired Armed Forces personnel and their families. Four per cent of those who have fought in Iraq and Afghanistan have post-traumatic stress disorder (PTSD), rising to 7 per cent among those who have been in combat, and 6 per cent of reservists. Many sufferers either do not know where to turn, or get lost in the system.
“We need to separate the wheat from the chaff and integrate services,” Wessely says. “Most veterans we see do not have a single straightforward problem and can face a bewildering landscape of services.”
Attitudes towards soldiers from mental health professionals, who often lack a detailed understanding of the role the military plays, are part of the problem. “I think we have to be a hell of a lot more respectful about the Armed Forces than sometimes I have encountered among my colleagues,” he concedes.
Wessely is married to Dr Clare Gerada, a GP and a former chair of the Royal College of General Practitioners. They have two sons in their 20s, neither of whom has followed their parents into medicine.
He says he was drawn to military psychiatry by a fascination with history as much as anything else. A decade ago he published a book studying the advances made in treatment of the mental health of soldiers over the great conflicts of the previous century; he remains intrigued by what we can learn from the past.
“We have not fully celebrated the role the military has played in the development of psychology,” he says. “War leads to major changes in medicine. That doesn’t mean war is a good thing but it stimulates change.”
In his research, Wessely studied the pensions of First World War soldiers reported as suffering from psychological issues relating to combat – a total of some 85,000 British troops. Many had reported neurological issues such as intense tremors, an inability to walk, loss of vision or uncontrollable fits.
Some of those testimonies make for painful reading. One soldier simply wrote of his experiences: “I was blown up at Arras. They dug me out three days later. And ever since then I cry a lot and I’m no longer a man.”
But the flashback, the hallmark of modern PTSD, was rarely described among those First World War records. “The disorders themselves have changed,” Wessely says. “Shell shock is not the same as PTSD. What we see now is more psychological.”
Despite the many horrors of modern warfare, Wessely insists his work has shown that joining the Armed Forces has a positive impact overall on a person – with one exception: a higher propensity towards committing violent offences.
A 2013 King’s College study found of 2,700 men in the military under the age of 30, 20.6 per cent had been convicted of a violent offence, compared with 6.7 per cent in the general population. Those who had been involved in combat in Iraq and Afghanistan were 53 per cent more likely to commit a violent offence than those in non-frontline roles.
“Something about combat mixed in with mental health problems and alcohol [causes] quite a considerable increase in the rate of getting a violent conviction,” Wessely admits. The reasons why have not “really been addressed yet”.
The old military adage that lessons learnt in war are quickly forgotten in peacetime applies equally to medicine. But unlike with previous modern conflicts, Wessely insists he and his successors plan to study the residual trauma of those involved over the next three decades.
They will focus not just on the physical and mental trauma of the individual, but also the ongoing impact on their family members.
“Not to lose sight of that – which usually happens – is important for the future.”
‘We can’t manage to see the Armed Forces as normal people doing a difficult job’