Army Life and Mental Health

Armistice Day takes place every year to commemorate the end of World War I – a time of great national pride, reflection and poppy-wearing. The sound of bells ringing at the eleventh hour of the eleventh day of the eleventh month acknowledges the sacrifices that brave men and women made for their country. Remembrance Sunday occurs on (or around) the eleventh of November, and is also a reminder of the benefits of peace that our ancestors bravely fought to bring about. These official anniversary commemorations, however, are sometimes overshadowed by accusations of hypocrisy towards the Ministry of Defence, given that they fail to speak about the billion-pound arms trade Britain profits from annually by selling high-grade weaponry to countries like Saudi Arabia and Syria.

Ex-soldiers I spoke to referred to senior military personnel who live within a bubble, often not knowing or caring about what goes on in the military and government. They question the point of commemorating the dead of past wars and praying for peace when Britain continues to vastly profit from arms sales which helps modern wars and dictatorship governments in power around the world. But these concerns are outside the remit of ordinary soldiers serving in the British army. They have their own issues to address, particularly their emotional well-being, which has become a focus of attention more recently in the last decade.

Historically, the army has been referred to as a racist, homophobic and male-dominated institution. Currently, only five percent of personnel are female. LGBT+ people have only been legally allowed to serve since 2000, but to date, very few soldiers are openly gay. The army is different now than previous decades with more emphasis on technology than war, guns and artillery because fewer conflicts are occurring in the world. The elite forces, such as the SAS, are given more investment. Overall, the military climate has switched to fighting Islamic terrorism with a shift towards intelligence gathering. But this does not preclude soldiers who are no longer going overseas to war zones on tours of duty, which often leads to burn-out after repeated times of stress, pressure and a lack of sleep.

The British army has decreased from approximately 120,000 to 70,000 over the last decade, because of austerity, restructuring and fewer global wars. However, many young men and women still apply each year. The target audience is those aged 16-24 who are attracted to risk and easily influenced. But why are young men attracted to a life and job that is physically and mentally hard and dangerous? A low-paid job (with a starting salary of £16,000) that could result in death or leave soldiers with appalling physical and psychological disabilities. A job which requires much time away from home and family. A job that is undervalued compared to the police or fire brigade. Yet none of this deters young people from wanting to enlist.

The army does not accept young offenders with unspent convictions or those who have committed violent offences. Nor does it take anybody with a diagnosis of ADHD (Attention Deficit Hyperactivity Disorder) and Conduct Disorder and/or is known to Mental Health Services. People who are physiologically well-adjusted and can self-regulate their emotions and anger in stressful and challenging situations are given preference. Prospective recruits undertake aptitude tests and several interviews before being accepted. More emphasis is placed now on training and apprenticeships, although new recruits are reminded they are soldiers first and tradesmen second. There remains a strict regime and discipline, but rumours abound of less harshness than in previous generations. These days, six young men may share a dormitory compared to twelve-plus in the past, and during training, there are fewer people per room, and duvets have replaced army blankets.

Although underfunded, the army still offers great opportunities – from employment, education and training to teamwork, purpose and confidence. It has been said that the army contains a variety of individuals from all sections of society. Those from working- and middle-class backgrounds join because they seek more adventure, many follow in their family’s footsteps, and some from poorer socio-economic backgrounds want to escape for a better life. They all have one thing in common, though, they want to broaden their horizons. The army does bring out the best in people too; it teaches confidence, self-respect, discipline, structure and routine. It also ensures recruits become physically fit and maintain good personal hygiene habits. In short, the army can change people for the better.

Along with job security, accommodation and food, soldiers can travel to various parts of the world, including Yemen, Falklands, Afghanistan, Iraq, Brunei, Cyprus, Gibraltar and Germany. They form strong, lifelong bonds with each other. Camaraderie in the army is established because of exceptional circumstances, and this type of connection is rarely found elsewhere. Conversely, there is also a higher chance of developing a mental health problem while serving in the army that may require professional help to overcome.

In the last 10 years, it is estimated that nearly 25,000 service personnel have needed mental health treatment. However, service provisions have decreased drastically in the past five years. There is a chronic shortage of military GPs, no psychologists, only a dozen or more psychiatrists and 85 mental health nurses. Increased media coverage of Post-Traumatic Stress Disorder (PTSD) and how it affects soldiers in their line of duty has been given more focus in recent years. PTSD has always been prevalent but is understood differently now than in past generations. For example, in World War II there was a common understanding among people about the effects of war because everybody was directly affected by it. These days, people are removed from war and if a soldier is shot or maimed while on a tour of duty, the general public, although sympathetic, soon forget about the suffering involved.

PTSD was introduced in 1980 by the American Psychiatric Association and was previously known as war neurosis, shell shock and nervous shock. To be diagnosed with PTSD, an adult needs to experience or witness a traumatic event directly or learn that a traumatic event has happened to a close family member or friend. They must also experience repeated or have extreme exposure to details of the traumatic event (seeing media reports, for example). People who have PTSD may continuously re-experience the event with thoughts or perceptions relating to it – this may include flashbacks, images, dreams or nightmares. People with PTSD are also unable to remember important aspects of the experience, and have enduring and exaggerated negative beliefs about themselves, others and the world. They might present in a persistent negative emotional state, with diminished interest or participation in activities they previously enjoyed.

Several ex-soldiers from Kent shared their personal stories and thoughts with me about the emotional state of past-serving personnel.

Paul

Death smells – and is never far away – and unless you have experienced its smell, you cannot empathise with others who have. Nothing prepares you for death, whether it’s the terrible sight of gunshot wounds, severed limbs or seeing people bleed to death. Training didn’t focus on death or the psychological impact of seeing it at close range. The drill at the time was to move on and keep your eyes open because you can never tell what’s around the corner waiting for you. Back in the 1990s, there was no welfare and nobody to talk to about mental health and how soldiers were affected by what they saw. Besides, soldiers are very proud and they don’t like sharing their feelings. I remember being in Bosnia in an area that had been heavily bombed when I smelt a sweet cooking smell only to discover that it was the smell of human flesh being burned. We had arrived in the aftermath of what was ethnic cleansing in this region. But we were required to remain focused on the job. Fear is part and parcel of being a soldier – fearful of doing something wrong that results in actions leading to something terrible happening to your fellow men – or the fear of being in a position of not being able to save them from the insurgent. You experience anxiety and pressure all the time.

Simon

I have one flashback that repeatedly comes back to me. When I was in Afghanistan, a woman came running towards me, shouting and screaming. I didn’t know if she was a suicide bomber so I pulled out my revolver and shouted at her to stop or I would shoot. Thankfully she stopped but by that point she had got up close to me and I could see her face. I can still see her facial expression. I keep going over in my head what could have happened if she hadn’t stopped, knowing what facial gunshot would look like and knowing that had I shot her, she would be dead and unrecognisable. In moments of intense combat situations, your adrenalin is all fired up. You barely have time to think. A split-second decision can be the correct one or one that you will have to live with for the rest of your life. Although I made the correct decision, this hasn’t freed me of constantly going over in my head what would have happened if I had pulled the trigger.

Jack

Everybody who has been in the army will know of another soldier who has committed suicide. Soldiers are more likely to commit suicide than non-military personnel despite greater awareness over the past decade about mental health difficulties like anxiety, PTSD and depression. Mental health remains a taboo subject for a great many soldiers. It doesn’t matter whether help is offered or not because those needing it the most are the first to push help away. Suicide is rarely caused by one thing. There are several factors, including direct after-effects from being in active combat, seeing dead bodies and having flashbacks with reminders occurring through sight and sound. Post-army life for many soldiers proves daunting. They see themselves going from ‘somebody’ in the army to an ordinary person on the outside. Some come out to unemployment or dead-end jobs. Suddenly they find themselves not going to work, being stuck at home, drinking and becoming more depressed. They experience difficulties in forging new friendships. The divorce rate is very high so it’s no surprise that arguments with a spouse are commonplace. Some spouses have a romanticised view of being married to a soldier but find the reality quite boring. The thing about mental health is that it is a hidden wound. Some deal with their problems after getting the correct support, others re-join after becoming stressed out with civvie street. They miss the camaraderie and security of having somebody looking after their back. Then there are those who become encircled in a dark hole where they can see no escape.

Several of the ex-soldiers I spoke with take anti-depressants which, unfortunately, had been spuriously prescribed by their GPs as an answer to the presenting emotional turmoil. Some medical professionals, however, with an in-depth knowledge of PTSD state that non-drug treatment is probably the best and most beneficial for the condition. Criticisms were also made about counselling support provided at their local practices. Referrals resulted in being seen by young counsellors (21 years old in some cases) rendering ex-soldiers embarrassed to talk with professionals who they felt didn’t understand their experiences. Some continued for a time, but others gave up after a few sessions.

They informed me that, generally, support is sporadic and sparse outside the army and in some cases, soldiers receive none at all. Many prefer this, though, as they consider it weak to admit to mental health issues. They rely instead on support from ex-colleagues who they know will understand how they feel. Counselling, however, is still the most recommended therapy to bring about emotional stability in trauma. Cognitive Behaviour Therapy (CBT) is considered a good talking therapy for PTSD or other trauma phenomena because its style involves gradually exposing the individual to the disturbing thoughts and images they encountered and replacing them with a more balanced frameset. It also provides an opportunity for therapists to offer guidance about grounding during flashbacks and explain how to self-regulate. CBT also works with clients who experience ‘survivor’s guilt’, a phenomenon where the person constantly questions their actions – e.g., could they have done more to prevent what happened?

Some say that it is fifty percent luck whether you develop a mental health problem in the army because it might depend on personality types. The ex-soldiers I spoke with said that broadly speaking, soldiers have two kinds of personality. The first is jokingly referred to as ‘Billy Big Balls’ – they claim nothing bothers them, irrespective of any trauma they see or experience. They want to be constantly seen as tough, macho and impenetrable. But nobody is invincible, and it is only a matter of time before life catches up with them. The other kind of personality is those who are more open to talking about their feelings among friends. They can be themselves (which can involve shouting and screaming) within context and get an emotional release after a challenging day. It also means they can discuss death with friends and understand their feelings around being saved, or not, if seriously injured. Some question if saving a life means ending up a triple amputee, whether it’s best to bleed out, and many want their friends to carry out this request should it happen.

Although mental health is discussed in the army, and soldiers are encouraged to recognise it in themselves and colleagues, emphasis is also equally placed on resilience. All military personnel are encouraged to deal with stressful and tough situations along the premise of being constantly expected to change, adapt and overcome challenging situations. However, after leaving the army, they are left alone to cope with the emotional aftermath and expected to develop their own coping mechanisms.

Ex-soldiers often allude to the support given to American soldiers – the Veteran’s Association receives government funding. Abraham Lincoln was quoted to me: ‘These men have done everything for their country, why can’t their country do something for them?’ The British Government offers no direct funding towards the mental health welfare of its ex-soldiers. Instead, it is left to various Christian charities and Help for Heroes, Combat Stress and Hidden Wounds. Help needs to be sought rather than automatically offered to those who have left the army and are struggling. Families often bear the brunt of those suffering from PTSD and depression, but unfortunately, they too are overlooked. When a loved one returns with PTSD, it takes a heavy toll on relationships, especially when the soldier is unable to talk about their feelings and takes their frustrations out on those they love.

While praise is mainly directed at charities which provide help to ex-soldiers, it does not mean the services are always reliable. One ex-soldier told me about a bad experience he had with one of these charities. He attended an interview consultation and contacted them six months later as they had not been in touch. He was informed that the nurse who completed his screening had been sacked and he would need to return to undertake a new evaluation. After doing so, he was told his screening fell short of an official PTSD diagnosis and he wasn’t eligible for counselling. At this point, he was taking anti-depressants and experienced suicidal ideation. A recommendation was made that he attend group therapy, only to discover the unit was miles away from his home. He felt the charity had no concept of distance, cost, work and family commitments and the experience left him feeling their way of working was unprofessional and uncaring.

Some pivotal changes have occurred in recent years for those who complete tours of duty in active war zones. They are sent to Cyprus for a period of decompression where they can relax and unwind in a safe, non-combative environment before returning home. This is an excellent opportunity to get plenty of sleep, eat a healthy diet and find ways to let off steam through exercise. Some soldiers state this is not always offered, however. There are sceptics who claim the army only offers this decompression to avoid future litigation – sufferers of PTSD have previously lodged lawsuits against the army for the emotional struggles they endured as a result of their life in the forces.

Many soldiers serve 10-plus years in the army, although some serve 20 or more if in senior positions. Some of the reasons for leaving include soldiers who become burnt-out after continuous tours of duty which sees them bored, unhappy and missing their families. Others leave after they get into relationships and discover there is a lack of respect for private lives. Some resign after realising that even as squadron leaders, their wages are less than takeaway restaurant workers. The first year after leaving the army is the hardest. Many leave and carve out new careers. Some return to college or university and qualify in a range of professions. The flip side, though, shows how some ex-service people struggle with civilian life and become unemployed, homeless or in the criminal justice system. Many get overwhelmed and depressed after leaving their structured life, and this often leads to drinking and drug-taking. More support should be offered at this point, including mental health provision, because ex-soldiers, as you have read, are more likely to be psychologically impaired by their forces’ experiences.

When the army was downsized, it was anticipated that many ex-soldiers would join the reserves, but this did not materialise. It was seen by many as a backward step. These people had experienced real army life and thought the reserves would be unsatisfying. Ironically, if ex-soldiers joined the reserves, these were the same people who chose to carve a life away from the military. Therefore, becoming a reservist would only remind them of a life that was over.

In the UK, public admiration and respect of ex-servicemen and women remain. Soldiers have a unique skill set and much to offer society when they return to civilian life. I asked all the ex-soldiers I interviewed if they had any regrets about serving in the army or if they would do it all over again. They all confirmed, without hesitation, that they wouldn’t change a thing. Even though most went into the army as boy soldiers – aged sixteen or seventeen – and at a time when they felt immortal, but army life formed and shaped them into the men they are today. Based on my experiences of meeting them, I formed the opinion they were good people who had integrity and a sound moral compass. Few have left the army unscathed by their experiences of warfare, however, and that’s why it is crucial to remember men like these on Armistice Day. We must be mindful of the bravery, suffering and human cost these servicemen and women have endured for their country, along with the after-effects they continue to live with long after their return from the war zones.