Many people leave the Armed Forces having had combat experience – often very soon after the end of a tour of duty, in response to the feeling; “I’ve been there, done that, got the tee shirt, now for something completely different…”
For some, their decision to leave at this point is closely related to having experienced combat, coupled with the unwelcome prospect of now-meaningless peacetime exercises and the re-application of peacetime regulations, administration procedures and attitudes. Such people are likely to experience problems adjusting to non-military life.
It’s well accepted that military units should remain together after a combat deployment, to prevent individuals becoming isolated among other people they feel do not understand what they’ve experienced. However, all too often, people depart their units: on promotion, for courses and delayed postings – as well as exercise their options to leave. The administrators of units are not always willing or able to oppose these peacetime requirements.
So individuals must themselves be aware of the importance of remaining with the people with who they do operational service, and resist their own inclination to leave – or the requirements of the ‘system’ to post them elsewhere.
Combat-related PTSD (CR-PTSD)
After operations it’s important to look out for changes in character or outlook– in yourself, and in the people who you served with; the people who know you the best. Such changes can be the precursor to what, if not identified and caught early, can develop into serious problems – including combat-related PTSD (CR-PTSD).
Statistically, most combat-related PTSD develops around 13 years after combat, but can equally be much earlier – and also later in life. The symptoms are hugely varied; from flu-like illness, to flash-backs and panic attacks. Many sufferers are unable to accept that they have a non-physical problem – and may refuse to accept that there is anything wrong at all. But the key symptom is uncharacteristic behaviour, which can appear in some as indiscipline, or to wives and families as withdrawal or bad temper.
When identified early, CR-PTSD can be prevented from developing further, and the sufferer taught to cope with it, can continue with a happy and fulfilled life. But if ignored or undetected, a downward spiral is usual: fatigue, withdrawal, illness, divorce, quitting the Forces, alcohol and drug abuse, violence and even crime.
CR-PTSD is not an illness, and does not indicate unreliability or weakness. Many undetected sufferers complete further operational tours, but will eventually reach a point at which they have to address their condition. This point is much better reached early. Those detected earlier, return to operational service better equipped to deal with its demands and stresses.
Dear Mr McManners
I know this is probably quite an inappropriate forum to use to ask you this question, but I respect your work and opinion very highly and had to take a chance that you might have a moment to reply. If not I completely understand, your body of work really is an answer in itself.
The truth is; I have felt drawn to understanding and helping post combatants and civilians since studying International Relations and Psychology at university. As life often turns out; my closest friends are from Sarajevo, children of the conflict there, and others have recently returned from tours in Afghanistan. I have asked them this question and would also love to hear your opinion on it:
If you could tell all students of CR-PTSD, future military psychiatrists and NGO consultants just one thing before they embarked on their studies; what would it be?
I know its a big question, and I suppose I’ve left it vague because I value any thoughts you might have. As I said before, of course, your body of work really does serve as communications enough, I am so grateful to have it to turn to.
Thanks for reading this!
Most Sincerely,
Eve da Silva
Hello Eve,
Thanks for getting in touch.
“One thing”… to guide an outsider’s perception of CR-PTSD…? Well….
I suppose the most common problem is that people don’t realise what’s wrong with them, until they do something dire or other people work it out for them. All they want is to be how they used to be. But that isn’t possible, because they’ve experienced war for themselves.
For would-be military psychiatrists; most CR-PTSD sufferers are better off being helped by their comrades, as they’re not suffering from any mental illness – although illness may well develop. We need to understand the mechanism of CR-PTSD and devise early diagnosis and effective treatment. This is a Command problem and only becomes medical in extreme cases. We urgently need a joined-up system to give the right help to people very early to avoid them having to see psychiatrists – first aid for the mind as well as the body…
Hope that makes sense!
All best,
Hugh