Private Bradley Paul of the 1st Battalion The Mercian Regiment severed an artery in his neck and had multiple bone fractures from the explosion in Helmand Province in November 2012. He was airlifted home and spent more than a year undergoing physical rehabilitation.
“Through the usual strength of character we all came to love about him and with the love of those around him he made a good recovery,” says the Go Fund Me appeal page set up to raise funds to pay for his funeral.
But the psychological wounds, less visible than the physical ones, became impossible to live with. On February 17, he was found dead at his home in Timperley. He was 23.
It had been a “silent struggle” according to Paul’s infantry platoon commander, Captain Chris Middleton. “He was a great character in the platoon. He was one of the guys that the other lads looked up to and respected. He was physically and mentally very strong and he had a very good sense of humour.
“As the front man of his patrol every day, Brad carried the weight of responsibility for lives of his mates on his shoulders every time he stepped out the gate.”
The government sends people like Paul off to the dark places of the earth, often for highly questionable purposes. They witness death, destruction, massacres, unspeakable acts of barbarism. They suffer great injuries. They see friends killed right in front of them. They kill.
Then they’re supposed to come home, keep calm and carry on as normal. Help with the school run, go to the cash and carry, Saturday night at the movies. “As you were, soldier.”
The return to civilian life can be some kind of nightmare. Everything looks roughly the same, yet everything has changed. You find you can’t go home again. You’re still at war. No one has prepared you for peace. There’s a good chance you’ll end up in prison, or homeless.
The Armed Forces have presented you with a cruel double bind: your experiences in the military might have damaged you psychologically, but you’ve been trained that you’re supposed to be tough and resilient and self-reliant—someone who doesn’t tolerate vulnerability, let alone ask for help. You’ve been chewed up, spat out, and now left to cope on your own. Thanks a lot for your years of service, your courage, your sacrifices—now go away.
Trauma is an unbearable, horrific fact of life. As with Bradley Paul, the suffering is usually silent, the wounds invisible. And it doesn’t just happen in war zones, far away. “Trauma happens to us, our friends, our families, and our neighbors,” writes Bessel van der Kolk in The Body Keeps Score. “One in five Americans was sexually molested as a child; one in four was beaten by a parent to the point of a mark being left on their body; one in three couples engages in physical violence. A quarter of us grew up with alcoholic relatives, and one out of eight witnessed their mother being beaten or hit.” The statistics for the U.K. aren’t quite the same--1 in 20 British kids have been sexually abused, for example; domestic abuse will affect 1 in 4 women in their lifetime—but still shockingly high.
Trauma can cause a broad range of distress. There is traumatic stress, there is post-traumatic stress, and then there is full-blown Post-Traumatic Stress Disorder. PTSD is a prolonged reaction to a traumatic event; it can also be triggered many years later. The Diagnostic and Statistical Manual of Mental Disorders (DSM), which has included PTSD since 1980, lists potentially traumatic events as combat, sexual and physical assault, being held hostage or imprisoned, terrorism, torture, natural and man-made disasters, accidents, and receiving a diagnosis of a life-threatening illness. Sometimes, however, events that seem quite small and insignificant to the outside observer can be profoundly traumatic. Most people experiencing a trauma do not develop PTSD—some helpful factors, writes Babette Rothschild in the seminal trauma book The Body Remembers, are: preparation for the expected stressful event, if possible; a successful fight or flight response; good developmental history, belief system, and internal resources; prior experience; and good support from other people.
PTSD is, like most psychological disorders, highly variable in its presentation of symptoms. But those symptoms are generally horrendous, dangerous and hard to resolve. It’s as if the traumatic event is still happening, right now, with your body responding as it did at the time, on high alert—heart pounding, fast-breathing, adenaline flooding the system. Another common symptom is dissociation—a shutting down; a kind of escape when there is no escape. Common dissociative symptoms include amnesia, fragmentation of identity, and feelings of detachment and unreality about one’s self, body and environment.
The DSM claims that a complete recovery happens within 3 months in half of PTSD cases, but that “some individuals remain symptomatic for longer than 12 months and sometimes for more than 50 years.” In fact, PTSD requires a lengthy, painstaking spell of support and psychotherapy. It takes time to build the necessary trust, and then time for the delicate process of revisiting the hideous trauma, physically and emotionally re-experiencing it, arriving at some kind of accommodation or resolution—what Peter Levine in Waking the Tiger calls a “renegotiation”—and starting to heal. The story is told and retold, imagined and reimagined. The losses are mourned. The trauma is named, described, spoken out loud. “Without a voice,” writes Kim Etherigton in Trauma, the Body and Transformation, “our body finds other ways to speak for us.”
Rothschild stresses the importance of “braking and accelerating” during the work with a therapist—the client gently revisits elements of the original event at their own pace, and if things become too overwhelming, one or both of you hit the brakes: slow down, do a breathing or mindfulness exercise, change the subject, stop. The potential for retraumatisation—the very opposite of healing—is great. Much more ammunition is needed to fight the enemy within than some Citalopram and a handful of sessions of CBT.
It’s particularly difficult work because the clients often feel highly ambivalent about it. The tendency for veterans is to downplay the problem and not seek help. Counselling is a foreign land for many of those who have served in the Services. How could a counsellor—especially a mere civilian—possibly help? They surely couldn’t even begin to understand what you’ve witnessed, the things you’ve done. What could they know about being in a constant state of super-anxious, hypervigilant high-alert, waiting to attack or be attacked at any moment. The fear of crowds. The rage. The isolation. The sleepless nights, the flashbacks. The urge to escape into drink, drugs, gambling. Or dissociation: the memory loss, the blackouts, those disturbing episodes where you find yourself in another town, miles from home, with no recollection of how you got there, or why. The powerful undertow of suicidal thoughts.
In her research on veterans’ experiences of psychological therapy, Camilla Stack concludes: “Practitioners working with ex-military clients should gain an understanding of military society and culture and appreciate its lasting influence, particularly in terms of power dynamics. They should be sensitive to significant cultural differences between the military and civilian worlds, and watchful for the concomitant risks of misunderstanding and judgment.”
The politics of trauma
The U.K.’s the Ministry of Defence (which has had its moments as the Ministry of Attack) has been reluctant to recognise PTSD, because it doesn’t want to pay for treatments or damages or otherwise be held responsible.
“It suits the MoD to minimise the numbers in order to reduce the extent of liability,” Tony Gauvain told The Guardian. He is a retired colonel, psychotherapist and chairman of the charity PTSD Resolution. (Another charity, founded 95 years ago, is Combat Stress , which provides specialist clinical treatment and welfare support to UK veterans suffering from a range of psychological injuries like PTSD.) “But given the numbers of people suffering symptoms now, and the latency of the condition likely to result in increasing numbers, there would seem to be a determination to avoid admitting there is a problem.”
How many deeply traumatised people, victims of domestic abuse, rape, violence, torture, organised crime, terrorism, wars—the old kind and the new, more insidious kind—are walking on the earth today, right now, in pain, having received no treatment at all? Very many. Trauma work, writes Judith Herman in Trauma and Recovery, is political because the sufferers are generally the oppressed, and the oppressed usually have no voice. The truth does not come out. There is no reconciliation. Human wrongs are not righted.
“Moral neutrality in the conflict between victim and perpetrator is not an option,” writes Herman. “Like all other bystanders, therapists are sometimes forced to take sides. Those who stand with the victim will inevitably have to face the perpetrator’s unmasked fury. For many of us, there can be no greater honor.”