Nursing the mental scars of war
Last Updated: 12:01am GMT 26/11/2007
The Government is unveiling a new scheme to help soldiers suffering from post-traumatic stress disorder. But for one widow, it is too little too late, Glenda Cooper finds
'Imagine your worst day and multiply it by a thousand," was how Captain Ken Masters described his time in Basra to his wife Alison. "In Bosnia and Afghanistan I felt I was doing some good. Here it's different."
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| 'Imagine your worst day': Captain Ken Masters killed himself in Iraq |
Four days before he was due to leave Iraq he walked into his small barrack room at Waterloo Lines military camp and hanged himself.
"He was out there looking after his men; why was no one looking after him?" his wife asks now.
Capt Masters is one of 17 serving personnel posted to Iraq and Afghanistan who have committed suicide; one in 10 of those who have died in these two conflicts have taken their own lives.
According to the Ministry of Defence's own figures, of 1,158 serving personnel who developed mental health problems - such as post-traumatic stress disorder (PTSD), stress-related disturbance and depression - between January and March this year, 499 had been in either Iraq or Afghanistan.
Other figures show that the number of reservists sent to Iraq who suffer mental problems has doubled since 2003.
The last military psychiatric hospital, the Duchess of Kent in Yorkshire, was closed after a review in the 1990s. The MoD says it is accepted as best practice to treat service personnel with mental health disorders in the NHS in conjunction with the Priory group of clinics.
It spent £3.4 million on 307 such patients in 2006-07. However, on Friday the Government announced that it was also unrolling a pilot scheme across six sites in Britain that will provide trained mental health therapists for veterans.
The mental scars of war have always been with us. The veterans of the First World War called the symptoms they brought home shell shock; the Second World War generation talked about "going psycho".
Today, the buzz word is ''post-traumatic stress disorder", a term describing a severe reaction to an extreme psychological trauma.
Yet the story of Capt Masters and others like him raises profound questions about whether the military establishment recognises the invidious nature of anxiety disorders, PTSD and their manifestations, ranging from suicide to violence. In one case a former soldier fired a crossbow at his wife after experiencing a flashback.
"If you have a guy who has been hit by an RPG [rocket-propelled grenade] then something simple like a metal bin lid falling to the ground can set off a flashback," warns Ed Tanner of the mental health charity Rethink.
Dr Mark Salter, a consultant psychiatrist in London, agrees. "About one in four soldiers will experience some form of mental trauma.
This can appear as night sweats, night terrors, self-harming. We may associate self-harming with women but you find it in veterans, too - whether hurting themselves with knives or just failing to look after themselves - not washing, not keeping themselves fit, anaesthetising themselves with alcohol and drugs."
Salter treated one veteran who had seen the dismembered bodies of children in a deep freeze while serving in Bosnia; on his return he experienced acute night terrors in which he dreamt he opened a freezer and found his family inside.
He suffered extreme anxiety, hyperventilation, cut his wrists and finally, on his son's second birthday, attempted to commit suicide by taking an overdose. "It was the strain of trying to be the cheerful dad, to adjust to normal life when he knew no one could understand what he had seen," says Salter.
Many experts now believe that while warfare has always exacted a toll, recent developments have exacerbated the problem.
"Because the Armed Forces are under more pressure, in the past you might have had one six-month tour in three years; now it's not unusual to have two tours in 18 months," says Tanner, whose charity, Rethink, is opening a new facility in Wiltshire offering accommodation for up to two years for veterans suffering mental trauma.
There is also another factor. In civilian life, a new therapy culture encourages us to talk about our feelings - but not in the military.
"The problem," says Prof Simon Wessely, director of the King's Centre for Military Health Research, "is that the things that make people good soldiers - stoicism, resilience, bravery - make them bad patients. It's a circle that is very difficult to square. Soldiers need to control their feelings, emotions and fears in order to go into battle and hence it is difficult later on to admit to weakness, fears and doubt."
Conflict has also evolved. "Conventional warfare as we understand it last happened in the Falklands," says Tanner. "It's all changed. You are dealing with an enemy that isn't clear cut."
James Hayter [not his real name], now 38, served in the first Gulf war in an artillery regiment. He was sent out to Iraq at the age of 20 and had no real idea what he was letting himself in for. He saw horrific injuries and deaths. Then, on the Basra Road, he was involved in a friendly fire incident.
Hayter was badly affected: "I noticed my character changing. I started to drink more and use drugs. I was very angry. When my partner was going to have a baby, the sergeant wouldn't give me leave for the birth, I was so angry, I just went Awol for six months. Of course then I couldn't do anything legal to support myself, so I just got caught up in bad company, drugs - everything except heroin - until I was caught and taken back."
He was discharged in 1993 but it was only four years ago, after going to prison for drug-related crime, that Hayter finally started to get help through Combat Stress, the charity that looks after veterans with mental health problems. He has subsequently been diagnosed with PTSD and receives an Army pension.
"The Army is changing, I think, but it's always one step behind," he says. "I speak to young lads who have been out in Afghanistan and Iraq this time and it's changed even from my time. You're not fighting an army that's wearing a uniform, you're fighting civilians and terrorists. How do you come back to civilian life after that?"
"With Afghanistan it has been particularly difficult," agrees Tanner. "We find people talk about seeing children picking up arms, kids being put on the back of bikes by the Taliban to shoot at our troops because they know our forces won't exchange fire. This can all have a massive psychological effect."
Too much of it unspoken. Alison Masters felt her husband, who committed suicide due to depression, was not able to articulate all his feelings. They had met when she was just 18 and he was 22. "He was my first love," she says.
Capt Masters worked for the Special Investigation Branch (SIB) - part of the military police - and, with Alison and their two daughters, Kirsten, now 16, and Hannah, 14, was posted all over the world.
He had worked in Northern Ireland, Afghanistan and Iraq, but when he arrived in Basra in April 2004, British forces were facing damaging allegations of abusing Iraqis. By the time he came home in late July, for 10 days' rest and recuperation, he had lost a huge amount of weight and was not sleeping.
Alison persuaded him to see the doctor back in Basra, but felt she could not voice her concerns to his bosses in case it damaged his career. "Ken insisted it would all be OK," she says. Yet her husband's mental health deteriorated very swiftly.
"At his inquest one officer talked about coming in and seeing Ken rocking back and forth on his chair, just staring at a blank screen," she says. "Why did no one say anything? Why can't the Army see that depression is an illness, not a weakness?"
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