Michael: My name is Michael Coates. I am a former fire fighter, but I am also a former soldier. It is the
stories from the individuals within this military community that I am desperate to document. Our next
guest is a British psychiatrist who has dedicated his life to his profession. His research has seen
advances in the treatment of chronic fatigue syndrome as well as military mental health. A former
president of The Royal College of Psychiatrists. A Trustee of Combat Stress. Who has a deep-rooted
passion for the history and understanding of PTSD and shell shock. Episode 27, Simon Wessely this
Michael: Were you born in Sheffield, 1956? What was childhood like?
Simon: Where are you from ?
Michael: From Hull
Simon: That’s where my dad moved, ended up. My father came as a child refugee from
Czechoslovakia. He was one of what was called Nicky Winton’s children. 600 Jewish children who
were saved by Nicky Winton in 1939 and he ended up in Hull in fact from the Kindertransport. He
came when he was 13. Went to Liverpool Street Station, spent 5 nights in a brothel, in the East End.
Which I think probably life went downhill for him ever since. [laughing]. Then he went to stay with a
family in Hull, where you are from. Spent the War there, joined in 1944, joined the Navy, he is not a war
like military person, but he served for a year, on D Day and his ship was sunk, twice, but survived. In a
way that was the most traumatic thing that ever happened to him. People say he was a holocaust
survivor which he wasn’t, he escaped. Then after the war he went back to Czechoslovakia to find out
what happened to his parents and family. They had all been murdered so he came back to Hull and
indeed he was adopted by that family who became my grandparents when I arrived. In Cottingham.
Michael: Oh Yes that’s where my dad used to live
Simon: Right by the church. And then he moved to Sheffield as a teacher. He taught languages.
Which I thought was a cheat as he spoke 5 languages anyway, my father does not work, he just speaks
languages. Then he met my mum and then they settled in Sheffield that’s where I was born, and they
lived there for the next 60 years in the same house.
Michael: Did he speak about things like the Kindertransport ?
Simon: Yes, he did. But People when I have done interviews before about my father, people, they want
to make more of it. It changed him as a person, that’s true. He was a natural pessimist he assumed
that the world would be bad. But It was not the biggest issue we had. There were one or two things. I
was not allowed to watch “The World at War” series, on the camps. No, He found that very upsetting.
But no, it was a thing I knew about he remembered leaving Czechoslovakia quite well. He was 13 but
obviously his story then changes . He then settles in Britain. Indeed, the thing he did not speak about
is his direct experience. He had a terrible night when his ship his job was to listen to German
transmission as his German was perfect in fact, he worked with Ed Miliband’s brothers, father who was
also a fluent German speaker and they were sunk. That’s what he did not like talking about and for the
rest of his life. He would have nightmares about that night in the North Sea when the ship was
overturned . It had hit a mine and ship had overturned. But I often talk about him with veterans to
make the point my father did not have PTSD, he was well. He just had nightmares once a month. My
mum would tell me about them. He lost all his hair when he was 18 and went completely bald from the
shock. But he was fine. He did not have a psychiatric disorder he would have been pretty unhappy if
someone had said he had or asked him to see a social worker. He had a bad war, or a bad night and
he remember about it for the rest of his life. He never forgot about and then later on in life partly
through me he started meeting Naval people who obviously really loved to meet him as there was this
big bond which my father didn’t really feel until he got to about 70 and then started to meet Admirals
and things like that. And they would say Mr Wessely it is fantastic to meet you and I want to take you
on a submarine, and they meant it . Do you mean that. “Of course, we will send a car.” And he quite
liked that and then he was blind by this time, not a war injury at all, it was leukoma. But he did then
after my mother died, he got very lonely. We had to change our house for him. He spent time at St
Dunstane, but he was not a military person.
Episode 27 Sir Simon WesselyDeclassified Podcast
Michael: The military influence as a child did not influence your decision-making going into psychiatry
Simon: If you had met my father you would never have met a less military person. He was culturally
quite Jewish. He had an accent he did not talk about his war experience, but he did spoke about
politics very leftish. I am glad he died before we had the referendum really, I am. He was very very
European really believed in European unity on the way of stopping horrors of history repeating itself
and we spent a lot of time in Europe as a kid.
Michael: I did not know that Alf Dubs
Simon: He was on the same train as Alf Dubs
Michael: I did not know that. That is amazing. We have covered the refugee crisis on this podcast and
the similarities are shocking and it feels like we are just forgetting?
Simon: We are. It was the 80th anniversary of the Kindertransport last year and there was a big
celebration and commemoration and part of it was to remember the past and there was still quite a few
of Nicky Quinton kids about 60 to 80 alive, my dad passed away 4 years ago. But part of it was to
celebrate their contributions to our life and our national life. My father was a very modest man. But
there were plenty there that had really made major contributions. My father in his own quiet way had
done a lot in Sheffield in charity work and that’s where he met Dale Winton not knowing who he was
and in the music scene in Sheffield but we are doing more this year again to point out that Immigrants
almost invariable give far more to this country than they take and my father owed his to life to this
country without any shadow of doubt and he was always unbelievably grateful and we paid it many
times over and it’s a story I do not tire of telling. And my wife who is much more famous Doctor than I
am and led our GPs for some time. She, I remember saying, during the referendum campaign when
there was this thing about immigrants filling out casualty and destroying our NHS she said but when
you go to A & E you are much more likely to be treated by an immigrant than you are sitting next to
one. She could not prove that was true, but I am absolutely certain it is true. And that has been the
theme and that I got from my father.
Michael: So, you went into Psychiatry in the 70s ?
Simon: 80s . I went to medical school in 1975. With no ambition to be a psychiatrist at all. There were
no doctors in my family. To this day I do not know why I decided when I was 15 to do medicine, I
honestly do not know why I went into medicine. I did not have any role models at all. I was much
better on the arts side. Partly because of my father and mum, music, history and things like that. I
went to medical school. I wanted to be a doctor. I wanted to do all the running around the doctor bits
which I loved and enjoyed but I found I was more attracted to psychiatry and it wasn’t very fashionable
in fact it was extremely unfashionable but I did my medical membership, cardiology, to do all those
things doctors do on film. The running bits really, I call it. I decided I was more of a walker and a
reader. I was quite a bookish kid really and physiatry became more and more attractive and by the
time I had finished house jobs I was sure I was going to do psychiatry and that meant coming to
London. I came to the Maudsley that was the place to train and I have been there ever since. That
was not plan. But if you had known me you probably would have guessed when I said at 16, I want to
do medicine I bet you end up at the Maudsley I bet you become a professor at the Maudsley. But that
was never the plan, but it suited my personality and character and what I was fascinated by.
Michael. You have had an amazing career so far, President of The Royal Academy of Physiatrist, you
won The John Maddock prize, you have done numerous researches including Military psychiatry and
also trustee of Combat Stress. But history is really important to you as well and understanding history.
We have just briefly overviewed it with the kindertransport and your father.
Simon: I think there is no question I got my love of history from my father and that’s the inheritance I
got I am quite certain about that. And it mattered and one of the great things about psychiatry the
knowledge of history is not just the accidental thing you can do as you retire and people start thinking
what Mozart died of, or Darwin’s illness. Or something like that. It is quite fundamental. I have just
Episode 27 Sir Simon WesselyDeclassified Podcast
spent a year chairing a review of the Mental Health Act. You have to know about the history of
psychiatry and coercion and asylums and if you don’t know about that then you won’t understand how
we got to the position that we have got in. And there is a lot about psychiatry on how we classify and
think about disorders depends on the profession and where we have come from and where we are
going, I don’t think that is true about any other medicine. Psychiatry is a necessary knowledge that
you need to have to partly to avoid making mistakes we have done in the past.
Michael: Let’s talk about the military psychiatry of things. Let’s push it all the way back to the Ancients
and we will come quickly to the First World War. Has there always been, when can we date mental
health ( PTSD) have we always thought about it has it always been a kind of thing?
Simon: That’s a phenomenal difficult question and the reason is the answer to your question we really
don’t know because we don’t have the sources, we think we do. I have got colleagues who read the
Homer and all sorts of things to look for cases of psychiatry disorder in the great Greek myths. But you
have to remind them that this is epic poetry interpreted verbally for hundreds of years before it gets
written down. These are not medical case notes. I don’t think until the middle of the 19th Century it is
possible to get really into the mind of people’s emotions particularly at War as the people coming to
war are illiterate. The leave not traces. Even the officer’s barely leaves a trace. I mean Napoleon,
Nelson’s captains are quite literate, and we know write a lot about what they thought. There is a
wonderful book as they proceed to Trafalgar, they have quite a few moments to the point they actually
fight. And they know they are going to fight. And they write letters their logs and beautifully analysed
but you really have to know an awful lot about the period to know what the words they are using mean
it means as the said like our words but they don’t mean the same it is not until the mid 19th century that
you can make something of the mid 19th century there is not such a thing they don’t exist that’s why
myself and Edgar Jones a historian I work very closely with we have not written anything pre the
Crimean War. We think it’s quiet, dangerous is not the word, but I think it is ill advised to speculate to
much and draw out. People sometimes use Henry the 4th as an example of PTSD . I think that is
pushing it. So, we stick to when people start to leave records when the words like mood, fear,
Michael: What were the early attitudes like in The Crimean towards psychiatry and towards anxiety
and emotions linked?
Simon: It is quite hard to say. We know a lot of it was expressed through physical symptoms so we
know in the American Civil War and the Boer War there were certainly a lot of soldiers who developed
lots and lots of symptoms quite similar to what we would call Gulf War syndrome in modern times so
they were , what we might call psychological distress through physical symptoms. We certainly know
many of them would be handicaped for years to come from civil war records. We know that many
would end up in asylums during the 19th century whether that was related to war is difficult to say.
Certainly, some would have war pensions started to get paid during the civil war a little bit. But really
the big change is The First World War. There is no doubt about that. What there is arguments about is
exactly what changed. The First World War changed. Shell shock arrives 1914 first described in 1915
by Charles Myers. Two things to say about that. Number one, Shell shock is not PTSD but if you read
about it what they are talking about is what we could call more neurological symptoms so you find
huge accounts of people who suddenly go blind or can’t speak and can’t see or can’t hear and they
shake and they have huge tremors and very strange walks and things like that and we do see that a
little bit I think we seen three cases in Afghanistan in what that generation would say that is shell shock
but what they didn’t have in the First World War was again when we talk about PTSD. We have had
Walter talking about it everyone thinks about shellshock they immediately think about the flash back. I
am walking down the street a car backs first I am back in Nam . And we can hardly find any
description of the First World War of the flash back. We found a few but very few. Now nearly
everyone describes that but very few describe the kind of neurological symptoms or we think it is a
different disorder or at least it mutates in the 20th Century into what we see now. Why it does that we
have a few theories, but we can’t prove any of them they are quite fun, but we don’t know why but we
are quite sure they are not the same thing.
Michael: So, shell shock because it was such widespread it became almost an epidemic for the British
Army, and I suppose everyone in the trenches. What was the initial treatments for it and how did that
Episode 27 Sir Simon WesselyDeclassified Podcast
Simon: It is very important. The first point is it did become an epidemic and by 1916 it was part of
the major manpower crisis along the Somme same happened to the French. The Germans . Exactly
the same. Similar symptoms and a similar realisation that this was a real problem for all of them. There
was not a single view of shell shock they actually thought what we now call concussion they did think
that and what we could now call concussion or mal traumatic brain injury closer to the original
description of shell shock they thought it was the pressure changes of the exploding shell nearby,
rattling the brain. They thought it could kill and cases that were largely anecdotal people found in
trenches completely dead but with no injury at all and it was thought that maybe their oxygen had been
sucked out of them and they suffocated. I think this was mythological. It did not take long until they
realised that something psychological about it as you could get it without being anywhere near a shell.
But people were getting this who had not been exposed to a shell. And the cost of industrialised
warfare was so getting so terrible this, it was quite hard to close your eyes that this could be a
psychological issue but the problem that they had then was the numbers were getting huge and the
treatments were not working and there weas no single treatment at any one time. They used to send
them back to England first of all. But that really did not work the asysmulms got full of shell shock
injuries. The Germans said if you cross the Ryne, war neurosis, you never came back. It was the same
if you crossed The Channel.
What they do in 1916 is they start to treat people as quickly as they could. Everyone thinks of
Craiglockhart, this lovely country house on the outside of Edinburgh, full of officers doing basket
weaving and walking in the woods. That is so exceptional it bears no relationship to how the vast
majority of people were treated. They were treated in huge tented camps. In the Euro Tunnel, when we
come out, what we first do is go to that huge supermarket and that shell shock hospital number 5 it is
where the as you get out of the tunnel There were 5,000 people there at any one time, they were not
getting …. They were getting a bit of exercise, food, a vague expectation to be a man and go back and
do your duty, that was the reality. It was done quickly and as near as possible to the front line and
done also with the expectancy that you would get better. That Is the birth of modern psychiatry.
Everyone who does home treatment or crisis intervention is practicing what we called forward physiatry
Michael: Was that developing as we were going. Was there psychiatry then?
Simon: They didn’t call themselves psychiatrists as the asylums they dealt with the schizophrenia then
but did not call it that. What we call bipolar, but the doctors call themselves psychologists, but they
were psychiatrist, but psychiatry it was such a stigmatised word and not really recognised it was called
the lunatic trade. The ones we know about almost invariable call themselves psychologists. And then
there came the real problem and this part of history most people are not aware of, the numbers were
still huge, and the army and the doctors started to think we are making this too easy. There are too
many cases of shell shock people are either unconsciously trying to get away from The War not
entirely surprisingly or even consciously some they thought some were lingering. Myers who invented
shellshock was fired. New guys came in and were much tougher and by 1917 they banned “shell
shocked” the word was banned, and it has never been used since.
Michael: Was it a medical term?
Simon: In 1917, Myers was dismissed, and a guy called Gordon Holmes and even his friends did not
like him just down the road from here, where we are talking. He basically thought it was cowardice and
he really did and he would say so after the war so the treatments got tougher quicker tougher shorter
and more military and as a way of trying to combat the epidemic exactly the same happened on the
German side as well a big kind of switch. And at the end of the war they had to think what had gone
wrong as they were now paying tens of thousands of pensions for shell shock. They knew thought it
had been a real problem, had it continued they would have lost the war. The Germans thought the
same. So, they had a Royal Commission of enquiry on shell shock and they finally concluded that shell
shock was not a legitimate illness. That really it didn’t happen where people were well led, trained,
selected. They thought it was a form of contagion or where we call secondary gain.
Episode 27 Sir Simon WesselyDeclassified Podcast
Michael: A direct correlation to someone’s moral fibre to be a man when you talk about selection there
Simon : Absolutely we need to select the right stuff
Michael: When you look at Wifred Owen he won the military cross didn’t he?
Simon: Yes, fundamentally a brave man. They had that problem and they also had to consider the
issue of cowardness that we don’t talk about at all and they had to talk about, and they had tools and
they had executed 250 soldiers for military offences very small number with cowardness and a smaller
number for shell shock. But it had happened. And how did they tell the difference between
cowardness and mental breakdown. It was a real problem for them. Finally, they just said anyone who
had proven their courage cannot be guilty of cowardness. That was the best they could do. But they
also said as they were fundamentally Victorians and Edwardians and they believed character was
essential and the fundamentals of shell shock was a failure of character. So, when we get to 1939 and
we know the War is coming. At the beginning of 1939, we have another committee which says what
are we going to do with war neuroses. How are we going to avoid the shell shock problems that we
had? They said “Shell shock absolutely banned. they said … we are not going to give it a label. We
are not going to allow let anyone leave the armed forces for a psychiatric reason. And we will not pay a
single war pension.”
Michael: During and after 1939?
Simon: Yes. That is how they start the war.
Michael: Go back to Craiglockhart Hospital. And Maudsley I suppose there are direct links. What was
going on there? What were they developing there? Why was it so different there? They were
encouraging things like poetry and nature and being almost relaxed and de compressed.
Simon: They did a lot of things there. Again, there was not one Craiglockhart . There was a couple of
consultants in fact the one that treated Owen became Urban therapy , which was basically work what
we will now call Occupational Therapy. We have William Rivers. Very famous, who was a lovely man,
who was a psychanalysis, who believed in Talking Therapies and would be quite influential but only for
a small number of people. He treated a very very small number of people. His case load was very
small. But of course, he treated Siegfried Sasson who did not have shell shock ( laughing) and has
been very influential since then. But we have to remember as I say the number of people who got that
kind of talking therapy over a period of time is tiny compared to the 5,000 people in each of the 5 shell
shocked hospitals. This was not how the ranks were treated. There was a huge class divide. You are
a veteran I know. But there is still a big class divide in the military. But it was huge in those days.
Even in diagnosis it was about class. But the other thing of the doctors only had one thing. Their job
was to get people back to the war. People forget that Rivers supported the war. He persuaded Sasson
to go back to the conflict others persuaded Owen to go back to the conflicts not to let down their men.
They were not anti-war at all. And it is wrong to portray them that way.
Michael: What was post 1918? What did we learn from that or did it become more difficult? It sounds
like we had been becoming more progressive.
Simon: It is a huge mistake to think that shell shock is the beginning of our contemporary
enlightenment and that there is a straight road from shell shock to PTSD. There isn’t. The Second
World War is actually more influential. We started with a doctrine . We stopped shooting people by the
way. The Germans started it . The Russians even worse. But we cannot hold that line. By Dunkirk
1940, MPs, most of whom were in uniform said look this is ridiculous this is too harsh we are seeing
people breaking down and we cannot treat people this way, so we back away. And then we slowly
rediscover the other lesson immediately act of expectancy recovery a system forward psychiatry that
we use in Normandy. Try to use in Italy but doesn’t really work . But it does work a bit better in
Normandy. And we will allow people to be discharged and we will pay war pensions. And finally, at the
end, we and the Americans we agree. By this time the Americans had fantastic data. Every man has
his breaking point in a condition of continuous fighting. Man will become less effective after 140 days.
And the two things that came from the second world war was people can only take so much. Which
Episode 27 Sir Simon WesselyDeclassified Podcast
was not the first world war, if you are good character you might have a breakdown, but you will get
better. In the Second World War most people if they are pushed one tour of bomber command 50% of
you will either be dead or pshyicatrially ineffective as that changes what is it that makes people fight
due to patronism . But in the Second War becomes overwhelming evidence that people actually fight
for their mates. Hence, we had the platoons. Coming from the Americans has not changed to this day
at all, the realisation that actually what really matters is the support of the 10 to 12 people around you.
And that becomes absolute standard of combat motivation and demotivation. You will break down
when that support breaks down.
Michael: And from The First World War and post Second World war The PTSD was still happening in
people’s brains, wasn’t it? It wasn’t being made up in the last 20 to 30 years .
Simon: No, but you are right. We are arguing that it took different shapes and forms. We think the
flashback for example we think is a nature in the change that happened after The First World War and
we think, we can’t prove this, that after the First World War it is the era of mass cinema. Everyone
goes to the cinema 3 or 4 times a week even if they are working class, whatever. If you look at early
war films so often it depends on a flashback. Every film Steven Spielberg made was always about
flashbacks. Previously, when we read peoples records from The First World War they talk about
nightmares, depression and even talk about impotence but they do not talk about flashbacks. But then
by the end of the Century they do start talking about flashbacks. We think cinema changes the way we
think about trauma. We can’t prove that or disprove that either, but it is quite fun. We do not see those
First World War films these people with grossly neurological disorders that are clearly Psychologically
induced but we have seen change. I have seen in two in Afghanistan, but they saw thousands. So,
something has changed.
So, what finally changes in 1980 is we have the diagnosis of PTSD and this comes from America and
people say that is a different reason when we finally acknowledge the psychological cost of war. But
that is complete nonsense. The Frist World War knew that. The Second World War knew that. They
had tens of thousands of casualties. Psychiatric casualties filling these hospitals. In the Second World
War they actually had a higher rate of psychiatric casualties. But what they said was this : if you break
down in war and you are basically of good character in the First World War ( that’s what they called it )
but later on they would say you had good parents or you were brought up you, had a stable
personality, whatever and over the course of the war you would get better. But if you do not get better.
And if you stay ill for a long period of time . Or keep relapsing. Probably the war was not really the
cause or the real cause was genetics they called it hereditary or your upbringing if you were more
psychoanalytically inclined the way your parents brought you up and then the war was merely the
trigger that is the doctrine and that is what changes in 1918 huge change the Americans start to say
long term illness in American veterans, Vietnam Veterans, is also due to the war and that is what is
different about PTSD. People have a great misunderstanding on what it is and what it is, and it is
saying you can be ill for many years and the cause of your illness remains your war experiences. That
is not what they thought in the first and second world war.
Michael: So, is that when we started developing in practices and therapies?
Simon: Yes, we do because, And the Americans lead on this as we are not in Vietnam. PTSD starts to
come into British thinking because of civilian disasters in the 1990s so Hillsborough, MS Herald of Free
Enterprise, The Bradford City stadium fire, the Kings Cross fire. We do not pay much attention to
PTSD when it arrives. We say it is an American thing. And of course, it was an American thing. We
were not in Vietnam and some of us think it is how Americans are coping with losing and it is a way of
trying to reintegrate the Vietnam veteran who is not being supported by the public, spat upon by the
public. In general, the Americans do support their Veterans. But nevertheless there is a lot of them
drug addicted, dangerous, depressed and need help and PTSD is the way they will get help and they
will get support and pity I don’t think this is what was intended but happens and will it take a while for
us to pay attention to this as we don’t see it as relevant to us.
Michael: When did we start seeing this ? did we go back to the second world war, the Crimean ?
Simon: During that period our main counter terrorist in Northern Ireland. We are not fighting the kind
Episode 27 Sir Simon WesselyDeclassified Podcast
of war we had done before. And we did not think we would get very high rates of psychiatric issues.
And of course, the Falklands would gradually have an impact. But not immediate, but later on.
Michael: Is that because of stigma and taboos?
Simon: Partly stigma, but I think it is because we continue to think that if you come back from
deployment and you are okay you will largely stay okay. That is still pretty true, but it is still the case
that the main predictor of long-term illness is short term illness and that has not changed. But it is also
because attitudes have changed. We are influenced by the Americans. There is a huge legal case in
2003 which says that the military has not cause PTSD. The cause of PTSD was either Jerry Adam and
the IRA or Guillermo in The Falklands, but it has to recognise the way it recognises it and treats it. And
it does. And that legal case does generate a change that we are going to do much more we are going
to treat it seriously and more research and reflect the attitude of society.
Michael: One thing I am getting is everything is changing. The conflict has change, media is putting
out there has changed. And absolutely one thing that has changed over the last 20 years is conflict
and the way that our troops are being used in conflict. 6 months on 18 months off and then 6 months
back on again and I don’t think that has ever been documented and used. What are we seeing from
that kind of intense war fighting especially in Afghan in 2007? A lot of the infantry lads especially and
front-line guys 6 months on 18 months off and then 6 months back on again. How is that ?
Simon: We have done a lot of work on that. The first thing to say is that you have to be careful not to
rely too much on the experience of World War One and World War Two where you are dealing with a
huge army many of whom are conscripted and you cannot compare that to an all volunteered
professional army They are different. And the experiences they are getting is different. We don’t really
have a war of attrition that we have in the Pacific or bomber command and one of the reasons why we
do have the 6 months on and 18 months off because the data from the second world war where you
join for the duration where if you go on D Day if you survive you will go right from the Rhine to Germany
we know that that has a huge psychology toll so we change and the Americans change too. And in
Vietnam ,we have one tour of duty you have done your duty and go home. They thought that would
completely solve the problems but of course it didn’t it is still the influence we have that’s why we have
the 6 months on 18 months off. We showed that one year was one of the considerable reasons why
the Americans have higher rates of PTSD is because they have a much longer tour of duty and shorter
down time. When the other thing they started doing during Iraq was they started to extend that, so you
had been there for 12 months and then extended to 15 months and their rates soared. We did same
with The Black Watch around Fallujah where we extended the tout and we were able to show that even
a small change in tour length against expectations had a very big impact. It was about expectations
and it was one of the reasons why we did not extend tour lengths.
Michael: We spoke about this on Sangin where the lads were literally getting on their flights home then
told another month of fighting. Quite fierce fighting and I know that has impacted a lot of Royal
Simon: We try really hard to, about that. We really did it is really about expectations and the advice we
gave. If you are going to alter tour length . You must not do it during tour. People need to know. And
families need to know. Dates must become sacred. It was quite substantial in people’s health alcohol
problems. PTSD etc with quite a small change. It was not about the length. It was about the change. I
do think we tried very hard to stick to a specific tour length. Some do much longer. People in
headquarters may do much longer tours but they are very different experiences and I don’t think they
Michael: One thing just popped into my mind there. I want to go back and then come forward again
when you said about HQ. The nurses in The First World War did they show signs of shell shock like the
troops did and are we seeing that now in Afghan and Iraq where nurses or people who are casualty
handling are, they are experiencing the same symptoms and trauma.
Simon: I know that RMC lost 10% of their strength killed, doctors and nurses in the first world war
which is roughly the same as infantry . They were very forward and 10% in the RMC is killed which is
Episode 27 Sir Simon WesselyDeclassified Podcast
the same. I don’t know what the figure is for nurses. They are likely to be a bit further back and the
answer is I don’t know. I do know now, that originally, we did show a slightly higher rate of mental
health problems in all medic personnel including nurses . Although when we repeated the study in
Afghan but there was a slight increase but certainly some of them do get disorders but in general
though when we have looked at different groups. The main things we know is the two groups that
have worst problems is the Reserves twice the rate to the regulars. And those in direct combat role
has an increase in PTSD which isn’t really surprising is it.
Michael: Why is it so high in Reserves?
Simon: The first studies we did showed that if you take the whole force there is no increase in the rate
of disorder who had been to Iraq and afghan to those two hadn’t. A huge people in combat support
different roles second because we have to compare like with like. We cannot compare civilians to the
military it is a meaningless comparison. And therefore there hasn’t been a time in recent years where
we do not have a non exposes control group. But reserves showed just simply going to deploy double
the rate of psychiatric disorder but let’s be clear it went from 3 to 6% it’s not 30 to 60% the vast
majority came back well. But purely deploying did increase the rate of disorders and that was still
present 5 years later and I think that is still the case now and we think it is due to homecoming. It is
not what happens in Theatre. It is the great difficulties that reserves have in home coming compared to
Michael: In what way? Just going back in and not being surrounded by that group?
Simon: The things that help you adjust when you come back. You can see people like me, my
colleagues, lots of formal social support, there are people like Padres the in between, but what really
matters is the informal social support, you get from families, your mates, barbeques, the chain of
command all of those things and of course by definition the reserves do not get that and here is the
paradox in order to reduce the rate of psychiatric casualties for the reserves you are going to have to
make them look like regulars and then the whole point of them has gone. And that is our wicked
problem. I don’t think there is a solution to that.
I remember my hospital is very friendly towards the armed forces and my universities as well. But when
people come back being reserves everyone is terribly interested but it does not take very long before
like if you are a medic a doctor quite well while you were aware we had to do your on calls and another
reorganisation and you forget about it. But if you are a regular when you come back the one thing you
do know is that your employer, the Army, does approve of what you have done. ( laughing) And that is
not the case we try to but fundamentally it is not really for civilians. It is not the same. And then there
is the support from you mates, colleagues and your family. If you are living in a garrison town it is very
different to if you are way out living on your own.
Michael: If we make the comparison with The World War One and recent conflicts, with a family or the
role that a wife or a partner would have had in the First World War where things changed a lot post
conflict where a daughter may have had to look after their father or the wife, their plans would change it
would be about the man in the house. And then we fast forward to Afghanistan. What are we seeing ?
or are we seeing any impact in the families, sons and daughters and wives and their future?
Simon: Yes, and it is a really good question. First of all, again comparison to the World War are very
difficult because we had millions coming back . There were a lot of concerns how veterans would be.
Spouses would get , because if you were not married it did not count , it was assumed you were
married , they got a booklet that their returning husband would have. Same with America and you read
them, and they are written in a way in that sound Harry Enfield is nevertheless they are pulling out the
problems of Integrations might be problems with violence they knew there were problems. Obviously,
there is more done for families.
If you look at the impact the first thing to say is it is not true to say that going to deploy leads to greater
breakdown. We have looked at after Iraq 7% of relationships broke down in the 6 months after Iraq but
a 7% broke down in those that had not been to Iraq. And then we look at children. And we know
overall that military children have higher rates of mental health problems, conduct disorders, or AHD,
Episode 27 Sir Simon WesselyDeclassified Podcast
anxiety depression if they are older and we were able to look and say why. Well one thing they say is
it’s about deployments, separation, but it is not. They handle separation very well. It goes with the
territory they get used to it. They often find families that not every soldier is a perfect father some
families function better but that is not the issue but what is the issue is when the partner and usually
the father but not entirely comes back with drink or mental health problems, PTSD, then that is why
you have the higher rates in children. It is not deployment per se it is coming back with mental health
problems that is affecting the child.
Michael: It is the impact of the PTSD, of the father has on the children?
Simon: That is exactly right. And I think that is quite important because they have a not the separation
it is when that association is with you developing problems and then it is transmitted back to the family.
Michael: I think that is a really important thing and knowing there is a responsibility and look after
ourselves and by that I mean serving personnel and guys who have left and that understanding you are
having a direct impact or your actions could go back on your children and the long term mental
well-being of your child as well especially if you have been in a frontline role or you are at a higher risk
to PTSD. What you have taught me today is that reservist really looking after yourself and the
understanding if you are reservist it can have.
Simon: They know that and they will do the best they can to maintain those bonds and it is those
social support bonds are so important and good ones will organise all sorts of funny things to get the
folks back together so they can decompress and they do go through decompression but it is quite a
short thing, we know it is helpful, but it is by no means enough but it is helpful but that is the kind of
thing that continually goes on to people who have served and in the informal way. And of course, we
have the TRIM system that we have set up and evaluate but again it is always about you don’t come to
people like me, psychiatrist, councillors, phycologists until it is absolutely necessary. The first line of
defence is you and your mates, and then it is the Padre and chain of command. We are there really for
the small number who have developed PTSD who need treatment with emotionally problems etc. and
don’t they are not mentally ill, but they need support and help and that should come from absolutely
within the unit, within the family within the existing social structures.
Michael: Because If we can hit it hard initially it can long term?
Simon: It is what the young Royal Princes are talking about. These are not disorders but it is good to
talk to share but with people who understand you at a place and time of your choosing very important.
Some people do not like talking straight away, that’s fine. There is no right way to do it.
Michael: But I think that’s where this podcast has impacted a lot of people. It is not always the
speaking, it is actually listening to someone else’s situation, experiences as well as a professional’s
guidance as well.
Simon: And what we found, and this is why the military sometimes get annoyed with us, is that there is
no single solution. Going right back to when people came back from Ops Grapple and Bosnia, we did
a study to look at who did people want to talk to. It turned out some people did not want to talk.
Others would absolutely definitely would not talk to their families and would only speak to people who
they knew in their units. Others wanted to speak to others, would speak to similar experiences but not
in their units. Some speak to padres but others definitely not. The military wanted us to say this is who
you should talk to at this time. And we said, no you can’t do that. You need a whole range of options
and you also have to have people to make the choices they are most comfortable with.
Michael: Where are we at now then with psychiatric first aid ?
Simon: TRIM is really very similar it is what we use the idea is you give everybody or a lot of people
really very basic knowledge in spotting when people are in trouble and let’s be honest it is not very
subtle. Someone drinking too much or not talking and then what you might do and my experience of it
most people actually know that already what we have done is it is okay to talk ask what you are doing.
Episode 27 Sir Simon WesselyDeclassified Podcast
You can even ask if you are thinking of doing something stupid and people get very frightened people
say the wrong thing and make it all worse. No no you won’t. Honestly, know its’ okay giving people
permission and oh yes, I can do that. You do not need to spend 6 years in medical school and 7 years
doing psychiatry but when someone has something like PTSD yes you do. But most haven’t and it’s is
spotting those who are going to need the next level.
Michael: What is the future of military mental help? The treatment of it and the what are we doing to
counteract some of the negatives ?
Simon: Well I think there are 2 issues there. One is that, our treatments have improved that’s for sure
and will probably be new drug treatments which will be appearing and will help. There is a lot of stuff
going on particulary in America where they have huge funds that we do not have and are spending
huge about to try and find more biological markers for treatment. Will that solve the problem. No it will
not. We will always have to mix in the psychological and social with the physical treatments they will
not be able to separate. Some of the issues we are talking about will not be solved by taking and drug
and some will.
I think the other thing that worries me a lot is the way in which there is a lack of understanding on what
really goes on with people who served, serving and served and I am worried if the public now tend to
see everyone who has served they are a hero and you and I know ( you in particular and not me) and
most are not hero’s they are professional they are doing their job or they are victims which is equally
wrong. And there is a view that something like 80% of the population believe if you served in Iraq and
Afghanistan you are very likely to come back with physical and mental problems. The answer is you
are not very likely. You may come back. But you are not very likely. And obviously our job is to help
those who have far better. But if we end up thinking that the Americans have done more particular
Vietnam and that everyone who has served will ultimately succumb and that being in the armed forces
is a toxic organisation that is probably the most dangerous thing we can do. We need to have a proper
view which actually for many people is the best thing they have done; it is the best time of their lives
and they will end up as better citizens. We have showmen that if you look at for example offending
rates your chances of getting a criminal record have reduced not increased, reduced. People forget
that. Unfortunaly, you do also have more violent offending thay is the downside. You are more likely to
be convicted for a violent offence. But overall, you are less likely to be convicted for everything. Most
veterans will get employment and do very well. We need to push that message that this is not a toxic
occupation. People do not need our pity, but they may need our support. And I think that is probably
the most dangerous thing that really worries me.
Michael: We have seen it again and again with, we are not going to go into it now, but with post
traumatic growth, conflict growth as well, people have experienced growth, people become really add
to society at a national asset kind of level where our service leavers can really impact the business,
society and the charity sector.
Simon: I could not agree with you more. We have published a paper about asking people about the
positive and negative side. One of the commonest things, they endorse, is that I now handle stress
better, not worse, but better. We had a paper years ago which I was interviewing someone on Bosnia
on Operation Grapple which was a nasty operation and very difficult and I was talking to this guy and
he suddenly leaned over and said “do you know what the best thing about that operation. He said it
was this Doc – serving in Bosnia made me appreciate living in Bristol. We used it as a title for a paper.
Michael: Simon, I really appreciate your time coming in today, thank you very much and we will leave it there.