Has this highly decorated hero been driven mentally ill by an anti-malaria drug tourists are still given?
NOVEMBER is a fraught month for Major-General Alastair Duncan. Fireworks transport him back into the thick of combat zones: he believes the bangs are mortar bombs, sniper fire, and that he is again protecting his troops. ‘He’ll say, “There are men in the hills over there. Quick, quick, we’ve got to get everyone inside,”’ his wife Ellen explains.
‘He thinks he’s keeping me safe from the enemy. He gets very agitated, very distressed, but he is still being an officer, organising people.
‘He has meltdowns, episodes of horrific violence, but I know it’s not him; it’s his illness. The man I fell in love with is a sweetheart. He still has character and courage. He is a leader.
‘He commanded British forces in Bosnia and protected a whole swathe of people who would have been murdered in the ethnic cleansing.
‘He cared deeply, too, about the men he led and he still does. He is a proud and private man but he has told me he wants to help other servicemen and women who are suffering as he is, and this is what propels me to speak out.
‘Alastair has been let down by the country he served with honour, and he’s not alone. I believe there are thousands suffering as he is.’
Maj-Gen Duncan, 63, DSO, CBE, had an illustrious military career. Among his regiment — then the Prince of Wales’s Own Regiment of Yorkshire — he remains the only officer since World War II to have been awarded a Distinguished Service Order while still in command.
Held in high esteem by his troops, he was respected for his sound judgment and consummate professionalism. He also served as Chief of Staff for the UN Mission in Sierra Leone.
Today, however, he is locked up in a secure psychiatric unit near his home in Somerset. Tragically diminished, he has been incarcerated for ten months. He has lost the capacity to read and write; outbursts of aggression are punctuated by periods of torpor. He can be sweet-tempered and affectionate; remote and belligerent by turns. His wife, and a growing body of expert medical opinion, believe his psychiatric disorder has been caused, in part, by the controversial anti-malarial drug mefloquine, or Lariam, which he was given for six months in 1999 before being deployed to West Africa.
Lariam is still prescribed to around 2,500 British service personnel serving overseas but it can cause depression, paranoia, psychosis and nightmares — around 1,000 have reported symptoms, although not all who take it are affected — and it is now the subject of a Defence Select Committee Investigation.
The MoD contends that Lariam is used primarily where other drugs ‘would not be effective or appropriate’. However, Conservative MP Dr Julian Lewis, chair of the Select Committee, believes the number of cases of military personnel reporting serious side-effects after taking it is ‘deeply disturbing’.
Mrs Duncan, meanwhile, is urging for a total ban on the drug. ‘I believe it’s a scandal,’ she says. ‘If 1,000 troops have reported adverse effects, you can be sure there are many others who have not.
‘The long-term effects of this will be more and more in evidence over the coming years. There will be a tsunami, and the MoD seems totally unprepared to deal with it.’
Maj-Gen Duncan’s case is a chilling one. Although he had an adverse reaction to Lariam, he was prescribed it for six months; even, it seems, after 2002 when he was issued with medical ‘dog tags’ — bracelets worn by people with serious medical conditions — warning urgently against its further use.
Later, while commanding troops on the UN Mission in Bosnia, he was injured in an explosion and subsequently diagnosed with posttraumatic stress disorder. Medical opinion supports Ellen’s belief that PTSD worsens the damage caused by Lariam: a combination of the two, she’s convinced, is responsible for her husband’s current psychosis.
Yet neither the NHS nor the MoD has acknowledged the link between his mental illness and the drug. Instead he has been diagnosed with Alzheimer’s, but Ellen believes his symptoms and his cognitive capacity, which has remained unchanged for the last two years, belie this.
‘Alastair still thinks very cogently; he has absolutely clear recall of specific events in Bosnia. He doesn’t repeat things as someone with Alzheimer’s would,’ she explains.
Moreover an MRI scan revealed no significant changes to his brain in two years, while someone with dementia would have deteriorated, she points out.
She is also convinced — and medical opinion backs her up — that because of the effect of Lariam on her husband’s brain, the anti-psychotic drugs and antidepressants he’s been prescribed worsen, rather than improve, his condition.
Expert diagnosis and appropriate medication have not been forthcoming under the NHS, she says, but she believes with the right treatment, he will recover well enough to come home.
To this end, she fights a remorseless battle on his behalf. She is strong, resourceful and compassionate; an eloquent advocate, both for the husband she loves unconditionally, and the cause she has taken up on behalf of him and thousands of other service personnel.
She is also funny, frank and voluble, but her outward cheerfulness masks fierce determination and anger. ‘I think I can save him. I really do,’ she tells me. ‘I believe he could come back home and enjoy some quality of life. He doesn’t deserve this. He always did his duty. He acted with absolute professionalism.
‘He has a photo of himself getting the DSO, and once he put it face-down, but I stood it up again. He said to me, “I’m not that man any more,” and I said, “Oh yes, you are. You went to Bosnia and a most difficult mandate. You saved so many people. You brought peace. That’s what you have to remember.”
‘Sometimes Alastair asks me: “What am I for?” and it’s heartbreaking. But I tell him: “In the future you’ll help others by telling your story and that makes you extremely valuable.”’
We must hope that he will. Meanwhile Ellen’s unswerving loyalty and love for the man she married, for better or worse, remains incontrovertible.
She visits him at least every other day — often daily — making the two-hour round trip from her 15th-century cottage near Yeovil in Somerset to the unit in Taunton. ‘Alastair was a highly motivated professional soldier, a strong, fit and active man. He loved skiing, riding and sailing,’ she says.
‘Now he’s confined in a unit with a chain link fence around it and he thinks he’s in a military prison. He just paces around. It’s horrendous.
‘I’ve sat at home and sobbed my heart out for him. I’ve come out of there howling.
‘Yet when he’s in a good place he’s kind, funny, loving and extremely good company. He’s my best friend. When I walk into the room his eyes light up. He says, “Oh Ellie, where have you been?” He gives me a hug, and I tell him all my news and he’ll be quite rational.
‘Sometimes, though, he’ll cry. Last night he sobbed his heart out about Bosnia. He gets very distressed by the fact that he couldn’t save everyone there. And in the past he’s had nightmares when he’s shouted out.
‘There is a lack of expertise in dealing with this complex sort of trauma,’ she adds.
‘The staff caring for Alastair are wonderful, but at a higher level there is not sufficient knowledge or experience in
‘Alastair has been let down by the country he served’
‘This drug is the worst form of friendly fire’
treating cases like his. He’s been on 19 different medications in the past nine months and most of them have made him worse.’ Ellen, 56, a designer and dressmaker, is Alastair’s third wife. He has three grownup children and two stepchildren from his previous marriages.
He, however, is her first husband. Ellen had devoted her late 30s and 40s to caring for her sick parents in their final illnesses. It is an abiding regret that she missed the chance to have children. She met Alastair in 2009, when her sister-inlaw, Caroline, introduced them. Alastair and Ellen’s brother Charles, a Colonel in the Prince of Wales’s Own, had been through Sandhurst together and remained firm friends. ‘Alastair walked into my house on my 50th birthday,’ recalls Ellen. ‘I was having a get-together and Caroline brought him. I’d never met him and I didn’t know he was coming.
‘But he walked in and I thought: “Is this my birthday present?” The poor man didn’t stand a chance!’ she laughs. ‘I fell in love in that instant. I think he felt it, too.
‘He told me: “I’ve been blown up and I’ve just had a divorce.” He’d also just been made redundant from running forces’ broadcasting.’
These experiences, she now believes, could have precipitated the ‘eruption’ of the psychosis that was then in its early stages. Their romance gathered momentum. ‘I saw him at the odd family do, then it just happened. He came here. I went to see him at his bachelor flat in Westbury (Wiltshire).
‘But there were hints, even then, that something wasn’t quite right. Alastair had strange memory lapses. I’d ask him to get something from the cupboard and he’d forget what it was when he got there.
‘He lost things; his wallet, his car keys, and got horrendously frustrated by it. In his emails, words were repeated, as if a needle was stuck. But I thought he was just getting over bad life experiences.’
There were, it emerged, two sides to Alastair: the lovable, amusing, attentive partner, who enjoyed every day pleasures with Ellen — shopping, visiting art galleries, travelling — and the man who succumbed to sudden, furious bouts of aggression.
‘He would hit a wall of rage, kicking objects, smashing things, and it would be completely disproportionate to the provocation,’ recalls Ellen.
In the summer of 2010 he drove off, during one such episode, and did not return for three months.
‘I was utterly miserable,’ Ellen remembers. ‘I sent him a couple of emails, but realised quickly he had to be on his own to work things out. Then two CDs — music he knew I loved — arrived in the post. There was no message. A week later, he walked back into my work room (the room with its mannequins where Ellen designs and makes wedding dresses) as if he’d never been away. I asked for no explanation, and he gave none. I was just glad he’d come back — and I knew he needed help.’
It is a measure of Ellen’s loyalty and unfailing love that she did not abandon Alastair. Anticipating my question, she says: ‘Why did I stay with this guy who has so many problems? Love. I love him whatever. I’d never walked out on anyone who needed help.’
Alastair’s fragile mental state did not deter Ellen from accepting his proposal of marriage, and their wedding was held in September 2013 at the village church they both attended. Ellen wore a glorious silk jersey suit she made herself; they had afternoon tea, a swing band, and a meal for 100 in a marquee behind their cottage. It was a blissful day.
‘I loved him; and as his next of kin I’d be in a stronger position to help him,’ she says. Indeed, she has spent the two years of their marriage selflessly doing just that.
And the path has been tortuous. Although they enjoyed periods of calm and contentment together, Alastair’s episodes of uncontrollable anger continued.
‘They were horrific, these meltdowns,’ says Ellen. She chooses not to be more specific.
Last Christmas he reached a nadir. After an outburst of violent physical aggression he was sectioned. Ellen recalls his bewilderment and anguish on being separated from her. ‘He said, “Ellie, where are they taking me? They’re trying to split us up,” and I said, “No, not on my watch. I won’t let it happen.” ’
For a few weeks his condition improved and he seemed well enough to go home, but in January he was incarcerated again after further violent episodes.
On two occasions, Ellen says, she has felt threatened, frightened by her husband. But her love for him abides; as does her conviction that, with the right professional help, he will return to live with her again.
However, she believes he will not do so until some of the resources — both public and private — that fund veterans’ charities are diverted into providing appropriate care for the thousands of service personnel suffering from complex trauma, as he is.
‘The Government has let down thousands of the most vulnerable servicemen and women who have fought to safeguard the security and democratic rights that allow them to govern,’ she says.
‘We need to acknowledge this. Yet the MoD continues to prescribe Lariam. And it’s a time bomb waiting to explode. It is, in my view, the worst and most insidious form of friendly fire.’