Theodore Stickley

SUMMARY: The author reflects upon the Gulf war in 2003; through statistics and vignettes the potential for long-term psychological trauma of those affected is considered.

AUTHOR DETAILS: Theodore Stickley trained in both counselling and mental health nursing and has taught both disciplines. He is now lecturer in mental health at the University of Nottingham.

The time it takes for articles to be reviewed for academic journals prohibits those addressing current affairs. At the time of writing, although the war in Iraq seemingly took only a few weeks, there continues to be death and suffering amongst the military and civilians alike and prisoners of war continue to be detained. During the build up to the war against Iraq, commentators paid scant attention to the long-term psychological effects that are an inevitable consequence of warfare. Whilst bombed buildings can be rebuilt, and, in may cases improved, the emotional and psychological damage inflicted upon people may leave scars upon individuals and families for generations.

If the language is anything to go by, the method of warfare employed by coalition strategists in the war against the Iraqi people, deliberately intended a psychological outcome. The language of ‘shock and awe’ implies the infliction of psychological damage on the lives of the population of the urban areas targeted with bombs. The psychological after-effects of the war are now only beginning. In this article I shall examine some of the expected psychological effects of war on Iraqi people based upon examples of post-war narrative.

When we examine the language of the U.S. military strategy, it is clear that what was intended was to deliberately inflict psychological damage on the population of Iraq, especially people in its main cities. To ‘shock’ is to deliberately traumatise. It is interesting to observe the relationship between shock and war. It was the recognition of the existence of ‘shell shock’ (especially upon officers) that first legitimised the previously inexplicable behaviour of apparently brave men deserting from front-line action. To shock, or traumatise, as a deliberate act is an effective way of psychologically disabling a person. The American military clearly intended to psychologically disable the Iraqi people. The word ‘awe’ is not so comprehensible in this context: whilst having a strong psychological component, awe, in itself implies religious reverence. Presumably, United States militarists intended to impress the Iraqi people into submitting to their god-like supremacy and might. The effects of U.S. weaponry were to possibly give the effect of a cataclysmic event, possibly even symbolising the end of the world and emulating the second coming of Christ.

Various diagnostic categories have existed that have assisted psychiatrists and therapists in the treatment of those affected by war. These include: shell shock, battle fatigue, combat neurosis, civilian catastrophe reaction, and, more recently, post traumatic stress disorder (PTSD). For the vast majority of those who have experienced the first hand effects of war, they will receive no diagnosis, treatment, therapy or help. The casualties of war are more than those who lose their lives, but also those who survive with maiming, those who survive having experienced the horror of losing loved ones to death or maiming, those who have witnessed death and destruction, those who have fled and left with feelings of cowardice and impotence, those who fired the shots and dropped the bombs, and finally, those who gave the orders. The politicians, being the ones who are ultimately responsible for the decisions to inflict the physical and psychological damage, are normally the furthest removed from exposure to the physical and psychological effects. In the democratic countries of the war alliance, the electorate must also take responsibility for the actions of their respective governments. The psychological effects of witnessing war through the mass media is not apparently a researched area.

Although the full scale military activities against Iraq lasted only four weeks, the long-term psychological effects are immeasurable. Psychological trauma manifests itself in any number of ways. For example during and immediately after the war in Croatia (1991-1992) there was an increase in suicides and other self-inflicted injuries in young people and the number of young people committing suicide continued to rise in subsequent years. Schools across the region reported growing numbers of hyperactive and aggressive children needing special care. Civil violence dramatically increased (Flögel and Lauc, 2003). The incidence of depressive symptoms and insomnia is widely reported amongst the elderly. Drug abuse is disturbingly frequent compared to the pre-war statistics. In Croatia there are more then 10,500 diagnosed cases of PTSD with probably many more unregistered. Studies estimated that patients suffering from PTSD have up to a seven-fold increased incidence of suicide, and four-fold increased risk of death from all external sources (Bullman and Kang, 1994).

Meanwhile the psychological impact of another war in Iraq continues to damage the mental health of a huge number of the population. Adults who may hardly have recovered from their experiences of the 1990-1 war and uprisings, and the suffering caused by direct experiences of conflict, bereavement and losses, now face chronic stress from the further threats. Women, especially those bringing up children alone or lacking family support, and children, already living in poor circumstances, disabled or lacking strong family support, are most vulnerable to emotional disturbance. The experience of another war is likely to magnify psychological disturbance already present in adults and children. After 1991 many Iraqi war widows became sole wage earners, often going hungry to feed their children; possibly 60% suffered from psychological problems, with physical manifestations such as weight loss and difficulty breast-feeding (Hoskins, 1997). Additionally, there is a psychological price to be paid in terms of the mental well-being of war veterans. For example, the Ministry of Defence record that of all illnesses reported by Gulf war veterans from the last decade 35% were psychological (M.O.D., 2001).

All wars produce refugees and displaced people. There are 53 million uprooted people in the world and more than half of them are children (UNHCR, 1995). 75% of refugees are in poor countries, barely able to care for their own people. About 5% are 'unaccompanied minors', children lost, separated or orphaned in the panic of flight (Ressler et al., 1993). The psychological damage and trauma of war lasts for decades. Millions of children have been bombed, shot at and raped; seen mutilated dead bodies; been present at massacres, murders, tortures and beatings; suffered separation from parents; and lived through events in which they defied death. War and violence are part of day-to-day life for many of the world's children. In their book No Place To Be a Child: Growing Up in a War Zone, Garbarino et al. (1991) explore the lives of the children of Cambodia, Mozambique, Nicaragua, the West Bank and Gaza Strip, and inner-city Chicago. Through research on the psychological and developmental effects of trauma in early life and interviews with children in war zones around the world, the book examines how children cope with war and violence. Noting that while most children can cope with horrible experiences and high levels of stress if they have a secure relationship with parents or effective substitutes, the book points out that they may face lifelong challenges to their mental health and psychological development. In the former Yugoslavia, interviews with children report nightmares, daily intrusive flashbacks, fear, insecurity and bitterness (United Nations, 1994). During the last decade, it is estimated that child victims of war have included 2 million killed, 4-5 million disabled, 12 million left homeless, more than 1 million orphaned or separated from their parents, and 10 million psychologically traumatised (UNICEF, 1996). Adolescents often suffer most because they understand better what is happening. Reports of 'weeping crises', attempted suicide, depression and increased levels of aggression and delinquency are common (United Nations, 1994).

What follows are three accounts of the long-term psychological effects of war relating to three different people in the U.K. Each story is based upon truth although some details have been changed to protect confidentiality. Each is given to demonstrate some of the long term psychological effects of war on individuals and their families.

In 1942, aged eighteen, Arthur was on a boat with his battalion heading for the Far East. The boat was intercepted by Japanese troops and Arthur’s commander surrendered into enemy hands. Subsequently, Arthur saw no further ‘action’ and spent the rest of the war in a labour camp on the river Quai. During this time he witnessed acts of violence that he later said no person should have to see. Many of his friends died of cholera, dysentery or malaria, many fell victim to the brutality of their captors. Returning from Burma after the victory in Japan, Arthur’s home was an over-crowded house in East London. He was welcomed by the wife he had married two days before his departure and his four year old son he had never met. Arthur worked as a milkman for a number of years whilst the family lived in a prefabricated house outside of London. As years went by and Arthur’s two children grew up, his attempts at denial of the horrors he had experienced failed. Every morning he could be heard violently swearing in the bathroom. Arthur couldn’t bear to touch his son and daughter. At times he would fly off in inexplicable rages. Both children experienced acute problems with self-esteem and struggled in work and building intimate relationships in later life. As a consequence, Arthur’s grandchildren are affected by the knock-on effects of his experiences in Burma.

Rose and Geoff grew up in the same Hampshire village. In the same class in their village school, they played together throughout their childhood. There were absolutely no surprises when they announced to their parents their desire to marry when they were both eighteen. Geoff secured a position as a civil servant with the Home Office and the couple moved to London in 1940. Geoff was killed in one of the first air raids upon London. He was twenty one years old. There was nothing left of Geoff’s body, his office had received a direct hit. There was no doubt that he was dead. Except that Rose could not believe that Geoff was dead. She began searching the streets of London. Irrespective of the dangers, Rose continued her search. The months turned into years and Rose eventually spent all of her time on the streets. In the last admission to the acute psychiatric ward, prior to her death, she was described as a ‘homeless paranoid schizophrenic with a long history of wasting NHS resources’.

There was never any doubt that David would join the army. His father and grand father had both served in world wars. David was tall and handsome. He served in Northern Ireland and Bosnia. Having spent ten years in the forces he had seen enough of military action and decided to work as a security guard for a local computer company. After only a few months, David’s wife Clare noticed an extraordinary change in his behaviour. He began drinking and bringing home new friends. On a number of occasions, Clare found David on the living room sofa in the embrace of strange men. David left his job and announced that he was going to become a film star. He would vanish for weeks at a time without explanation. Clare talked endlessly with David’s parents desperately trying to find some explanation for the change in his personality. In his suicide note, David recounted the occasion of the bullet from his rifle smashing the head of a thirteen year old boy in Bosnia. David left a wife, a daughter of ten and twin boys aged thirteen and a half.

What is presented are three stories tragically typical of the psychological effects of war. Throughout every day of the twentieth century war ravaged one country or another. It is impossible to begin to estimate the psychological effects of war on the world’s population. Not just the experiences of loss and bereavement but also the survivor’s sense of identity and self-worth; not just the survivor but the knock-on effects to relationships and parenting. How could we ever calculate the grief experienced by the millions who have suffered loss? The psychological effects of war are well documented and were deliberately intended in Iraq through the language and actions of ‘shock and awe’. As those who work with people trying to pick up the pieces of psychological damage, we need to question the morality of deliberately maximising psychological trauma through warfare. Whilst countless millions witness ‘shock and awe’ as Hollywood type movie images through television screens, not unlike enhanced graphics of computer games, the reality of warfare for those caught up in the real life action is perhaps the most psychologically damaging experience one could possibly imagine. Western alliance politicians and voters justified this war in order to challenge the so-called ‘axis of evil’ that apparently threatens western democracy. The use of the word ‘evil’ once again implies a religious and moral content to the conflict. The lived psychological experience of surviving being the ‘collateral damage’ of a ‘smart’ bomb is nothing whatsoever to do with the individual’s moral position of being good or evil. Whilst not wishing to develop a moral argument about war, we might ask how the individual survivor may comprehend and come to terms with their trauma with the added knowledge that they are a victim because the actions of the perpetrator of their injuries/loss were justified in order to eliminate evil. Iraqi civilians may well have wished the overthrow of their despotic leader but at what personal and psychological price?

Psychologists and therapists are left to reflect on their political responsibility towards war. Should we be content to simply be relied upon to provide therapy for victims or should we be actively campaigning against armed conflict? The ‘war on terror’ may provide us with plenty of opportunities in the future.

Bullman, T.A. and Kang, H. K. (1994) Post traumatic stress disorder and the risk of traumatic deaths among Vietnam veterans. Journal of Nervous and Mental Diorders, 182, 604-610

Flögel, M. and Lauc, G. (2003) War Stress ­ Effects of the War in the Area of Former Yugoslavia. Unpublished report. Faculty of Pharmacy and Biochemistry, University of Zagreb, Croatia

Garbarino, J., Kostelny, K. and Dubrow, N. (1991) No Place To Be a Child: Growing Up in a War Zone. San Francisco, Jossey-Bass Inc.

Hoskins, E. (1997) Public health and the Persian Gulf War. In B. Levy and V. Sidel (eds.) War and Public Health. New York: Oxford University Press

M.O.D. (2001) http://www.mod.uk/issues/gulfwar/map/coker.htm accessed 25/02/04

Ressler, E. M., Tortorici, J. M. and Marcelino, A. (1993) Children in War: A guide to the provision of services. New York: UNICEF

UNHCR (1995) Office of the United Nations High Commissioner for Refugees. Refugees at a Glance: A monthly digest of UNHCR activities. UNHCR, July 1995

UNICEF (1996) State of the World’s Children. UNICEF

United Nations (1994) The Sixth Periodic Report on the Situation of Human Rights in the Territory of former Yugoslavia. Submitted by Tadeusz Mazowiecki, Special Rapporteur of the UN Commission on Human Rights, E/CN.4/1994/110, UN Commission on Human Rights, Geneva, 21 February 1994, p. 34

* This article appears in the Journal of Critical Psychology, Counselling and Psychotherapy, 2004, 4, March

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