PTSD is an abbreviation for post-traumatic stress disorder. A term that has become a part of the twenty-first-century narrative in society. However, how significant is it in the institution of the British Army?
The purpose of this webpage is to show the attitudes of the British Army towards PTSD. It shall focus firstly on responses to cases of mental health injuries in the Great War 1914-1918. Then it shall discuss the impact of the Afghanistan War 2001-2021, and the Iraq War 2003-2011 on veterans. Has the British Army changed, or not changed, its attitude during this period and to the present day? The webpage shall discuss that although making attempts to improve, further developments are needed.
What is the definition of PTSD?
As with all disorders, PTSD has a range of mild to extreme levels of symptoms. It is defined as ‘’a psychiatric disorder that can occur following exposure to a traumatic event.’’[1] Its most severe symptoms can impact daily life. Shown outwardly in different ways, deep suffering is internal.
It is as an ‘’invisible wound.’’[2]
Onset of ‘’Shell Shock’’
As the Great War began in 1914, and progressed, it became clear that the British Army needed more human resources on battlefields. Volunteer army and eventually conscripted soldiers, from all walks of life, were thrown together to do their duty for their country. As the horrors of the conflict bombarded them, they were subjected to intense exposure to traumatic experiences.
During the winter of 1914 -15, soldiers began presenting symptoms, physical and mental.[3] Army doctors and physicians were bewildered. By February 1915 Dr. Charles Myers who was attached to a volunteer medical unit in France, wrote an article in which he gave shell shock its “official existence in medical discourse’’.[4] Indeed, by July 1915, trench warfare was ‘’producing an epidemic of shell shock.”[5] Its increasing numbers and symptoms created confusion as to whether the soldiers suffered physical affliction to their nervous system or emotional disturbances of the mind.[6] Their ailments and experiences differed, baffling those who attempted to medically explain the disorder.[7] Even Myers could not conclude in his report if shell shock was a “physical or psychological response to an incident.’’[8] The latter explanation would be on par with the definition of PTSD today.
The author Samuel Hynes says that the Great War ‘’added a new scale of violence and destruction’’.[9] This had a profound effect on the soldiers mentally as well as physically. The British Army had to determine how to deal with this dilemma which was unprecedented ground for them.
By the end of 1915, the British Army Council created two classes for shell shock. Soldiers who developed nervous symptoms from being in combat were classed as ‘’Shell Shock W”. Soldiers presenting mental symptoms, but not as a result of direct combat, were classed as ‘’Shell shock S.’’ Only ‘’Shell Shock W’’ casualties were eventually given military pensions.[10] Evidently, an unfair attitude existed among the British Army Council. Loughran researched a survey by Dr. Harold Wilson, published in 1916, which contested that system.[11] Gradually, medical personnel understood that physical effects of shell shock were indeed “psychological disorders.’’ [12]
image from https://bodminkeep.org/wp-content/uploads/2020/08/Shellshock2.jpg
How else did the British Army respond?
For the army, theories presented by doctors such as Wilson and Myers created complications. Examinations by psychologists hindered their aim of winning the war.[13] Those within the Royal Army Medical Corps (RAMC) considered neurology or mental medicine as a ‘black hole.’’[14] It was unknown territory that they did not want to readily recognise or enter. It can be argued, that the British Army showed a similar hesitant attitude to acknowledge PTSD a hundred years later.
How was shell shock treated?
It became apparent, that different ranks of soldiers received different treatments. The Army’s attitude could be considered brutal, especially at the start of the war. If a soldier showed no obvious physical reason for not being able to fight, they were shot.[15]
This fear was clear in the recollections of Edward Bigwood of the Worcester Regiment, “We’d rather lose a leg, be wounded, anything but to have shell shock.’’[16] This was supported by British officer F. Jourdain ‘’people always thought it was cowardice … you’d do your best to hide it.’’[17]
Military authorities tried to contain the condition with ‘’forces and discipline‘’. But after the Somme in 1916, shell shock could no longer be ignored. [18]All ranks were affected. Norman Dillon of the Tank Corps said ‘’ I come across a Major he couldn’t move …it was what used to be called shell shock.‘’[19] However, not all had the same empathy from the army. William Collins of the RAMC explained, as a rule, they were either “charged with malingering or sent down to a hospital and it depended on the officers they were dealing with.”[20]
This is discussed further by the author Peter Leese in his book on ‘Shell Shock: The British Soldiers of First World War”. He explores how treatment and levels of compassion varied ‘’corresponding to the rank of the sufferer.”[21] It was considered that suitable treatment was to give soldiers short rests and necessary medical remedies.[22] The British Army set up several medical clearing stations in France, most no more than ten miles from the frontline. Treating soldiers with shell-shock symptoms near the front line meant quicker recovery and return to the battlefield. However, it can be argued that recovery rates were not so positive. To get men back on the battlefields, Wessely and Jones state in their book, the military’s harsh attitude meant psychiatrists had to prove their worth to the army in curing the soldiers.[23]
Additionally, some army hospitals were created in England.[24] More detailed records were written on those patients. In the National Archives, medical reports on J. Milner and Private H. Spink show shell shock noted as a symptom of illness. The report written by a RAMC captain, records that Milner was injured at Ypres in 1915.[25] Significantly, this shows that shell shock was a result of direct combat.
After the Great War, a report was issued by the War Office Committee in 1922. It followed an investigation into the ‘’nature and treatment of shell shock during the war”.[26]
“War neurosis was now a political question.’’[27]
722,000 men died in the Great War trenches men from working-class and aristocratic families.[28] However, army representatives on the committee were mostly elite. Extracts of the report, seen in the National Archives, concluded that the conscription of ‘’untrained men’’ who differed from the regular army, increased ‘’shell shock” cases.[29] The army deflected blame on those from lower classes who had no voices in the report. Therefore, on the committee, the apathy of the army was clearly shown. Desperate for more soldiers, they had accepted conscripts to their units. Now desperate to save their manly pride, they readily blamed the lower-class soldier for having shell shock.
Future recruiting recommendations were set out. Emphasis was to be on strict discipline and morale.[30] Any ‘’loss of nervous or mental control’’ was not to be an ‘’honourable escape” from conflict.[31] As written then by the military historian Sir Michael Howard, war was considered to “define masculinity” in British society. [32]
This would support how thousands of British men eagerly volunteered for action at the start of the Great War. Those who had the privilege of private education learnt that self-control was of utmost importance.[33] Bogacz mentions this in his article. He says one psychologist F. W. Bunton Fanning, stated in ‘The Lancet’ in 1917, that public school soldiers were “less prone to shell shock”.
“Character and manliness are developed side by with learning.”[34]
When presented with difficulties in life, this social class were taught to have a “stiff upper lip” and forget any feelings rather than immerse in them.[35]Therefore, the British Army believed that soldiers and officers from the upper social class were more prepared in strength of character for war. In treatment for shell shock, “promotion of manly self respect” was an important “therapeutic tool.” [36] Indeed, Shepherd states in his book, that mental illness showed weakness of character and no “self-control”.[37]
It became evident that the British Army’s attitude viewed the symptoms of soldiers according to their backgrounds. Leese says, the working class suffered shell shock as a result of physical injuries or hereditary mental illness.[38] Officers suffered due to the weight of responsibility they carried as military leaders on the battlefields. [39] This displays an unfair attitude. Concerning treatment, the lower-ranked soldiers were considered uneducated in the opinion of the army and so unable to respond to ‘talking’ psychological treatments. Instead, they had electric shock treatments if necessary.[40] Social class was therefore the main variable used by the army to determine diagnosis and form of treatment.[41]
After the war, Charles Wilson, a medical officer on the Western Front wrote “The Anatomy of Courage” based on his diaries. He believed every man only had a “limited bank of courage. ”Every man had “his breaking point”.[42]
The Great War proved this theory. Shell shock did not differentiate.
Exposure of PTSD
In 1980, over half a century after the end of the Great War, the term ‘Post-traumatic Stress Disorder (PTSD) was used for psychiatric injury.[43] The American Psychiatric Association added the term to the diagnosis and statistical manual. “The true cost of trauma was finally acknowledged”. [44] It achieved to bring soldiers’ plights to the public’s attention in a way not heard of since shell shock during the Great War.[45]
Years later UK Armed Forces were involved in two conflicts: The Iraq War 2003-2011, and the Afghanistan War 2001 -2021. One veteran of these conflicts is Geraint Jones. His book “Brothers in Arms” is a personal account of his tours in those conflicts and his attempts at adjusting to life back home. Eventually, he realised he had PTSD.
“The condition is not a war hammer banging at the shed of my mind; rather it is an insidious virus that seeps in through cracks in the Armour”.[46]
Like shell shock in the Great War, Mild Traumatic Brain Injury (MTBI) came to the fore during the Iraq and Afghanistan conflicts.[47] Modern warfare of Improvised Explosive Devices (IEDs) was a “significant threat” to military personnel in Iraq and Afghanistan.[48] Following the conflicts, soldiers reported that IEDS exposure was a cause of their symptoms of PTSD. High-velocity explosions caused “signature injuries” to troops, with symptoms having “much in common” with those of shell shock.[49] Many of those suffering PTSD today are veterans of Iraq and Afghanistan. Although developments have been seen in medical treatments for psychological disorders after IEDs, attitudes in the army towards those who suffer could still be much more supportive.
‘Veteran State of Mind’, a podcast set up by Geraint Jones, focuses on discussions about PTSD. In an episode with a veteran of the British Army Special Forces, ‘From Baghdad to Breakpoint’, he relates the fear of coming out with PTSD. If weakness was shown in the army, soldiers ”get thrown on the pile.”[50] He criticizes the British Army’s support of PTSD sufferers,
“NHS problem, not army’s problem.”[51]
Scan this QR Code to listen to the episode where Geraint Jones talks with former Paratrooper, and SFSG soldier, Dave Radband. Some of the topics in this episode include; combat in Iraq and Afghanistan; why Dave was reluctant to believe that he had PTSD; and how he came back from attempting to take his own life. (Please excuse any strong language in this podcast).
However, some methods were introduced by the army during that time. Third Location Decompression (TLD) was set up to transition soldiers from active combat to home.[52] This meant spending a few leisure days at another location before returning home. The Chilcott Report in 2016, which focuses on the legitimacy of UK participation in Iraq War, states this as a “major development in health care.” [53] However, it could be argued that this time out was a temporary measure, similar to the short stays at frontline hospitals for shell shock sufferers in the Great War.
The Chilcott Enquiry notes that between 2003 – 2008, 87% of casualties suffered traumatic injuries, with “long-term outcomes of these unexpected survivors not known.”[54] This refers to those with lasting invisible mental wounds following combat, rather than physical injuries.
Now and in the future
“War not only kills and wounds, it also generates some of the most intense stressors known to men.”[55]
Every day, British Army personnel are on duty. Any day, an extreme event could occur in the line of duty causing lasting reactions of PTSD. According to a Veterans Office factsheet published in 2020, about 15,000 leaving the armed forces every year. [56] So, transition from army life should be as smooth and as positive as possible. However, if suffering PTSD symptoms, this can be challenging.
What support is available?
Evidently, the nature of transition from military to civilian life is underestimated. A soldier gives all to the army and can be at a loss when that is taken away.
Fortunately for veterans, many charities exist. But what of the army’s attitude? Once they have served their duty, is a soldier’s future irrelevant to them? Certainly, more can be done by the army. At present there seems to be too much dependence on the National Health Service (NHS) as well as charities for support. According to the Ministry of Defence veteran factsheet, “Mental health care is primarily the responsibility of the local NHS across the UK”, [57] Considering pressures on the NHS at present, and the varying priorities of different health boards, is consistency in this provision possible?
An example of this is conveyed in a recent BBC news report about a veteran who committed suicide in 2019. He had received treatment for PTSD whilst living in Essex, but when moved to Wales was on a waiting list for five years. The Welsh Government states that 115,000 veterans live in Wales, a higher percentage than in England. Data shows that 77% of Welsh veterans experienced “at least one military trauma” when serving. [58]This is a potential 77% suffering from PTSD symptoms.
Concerningly, March 2023 is when the Ministry of Defence first published a report on suicide rates in the UK Regular Armed Forces. It states between 1984 and 2022, 922 suicides were recorded. 581 were army personnel.[59] These rates were comparatively higher among young army males than the UK general population.
Further highlighting the lack of support is another recent BBC report in December 2023. It says that more veterans are seeking help, but the path to get there is a maze. This has resulted in a lot of “small charities doing their own thing.”[60]
So, no consistency.
Not all veterans have positive experiences in England either. A video report by the Guardian newspaper describes how because of a lack of support service, a group of British Army veterans in Dorset set up their mental health hub in 2017. In their words, PTSD is like “living in a storm.” [61]
One army veteran says, he felt “useless, worthless” on leaving the army. His experience meant he found the British army recruiting advert being hypocritical with the message “This is belonging.” [62]
In the words of another veteran, the army “swallows your soul and spits you out.” [63]
Although these men are proud of their military careers, the lack of support and guidance after discharge implies an ignorant attitude by the British Army. In its foreword, the TRIAD study by KCMHR, states that “leaving the military introduces rupture across all levels.”[64] It acknowledges that many transition well into civilian life, but for others “medical conditions” including PTSD, can make it challenging.
A document titled “Values and Standards of the British Army” published in 2018, listed values expected from soldiers: respect for others, loyalty, and integrity.
Integrity, as it states, is “quite simply, doing the right thing.”[65]
Do veterans today feel the British Army reciprocates these values to them? Evidently not.
One could argue, when you’re in you’re in, when you’re out you’re out. But as soldiers are expected to give “selfless commitment”[66] whilst serving, inevitably, similar undertaking in return would be valued with the task of establishing civilian life.
Another British Army value is courage.[67]
“Courage…a quality needed by every soldier”. [68]
It could be argued, that “courage“ should be demonstrated when serving and as an army veteran. Courage in all situations. “Physical courage is the readiness to confront and overcome fear and fatigue”.[69] On the battlefield and in society.
However, extreme trauma and life-changing events can lead to PTSD. Victims experience failure if courage deserts them. Often soldiers and veterans with PTSD blame themselves for failing to hold on to those values instilled in them by the army. As Geraint Jones said in his book,
“I failed as a soldier, I failed as a man”. [70]
This echoes the attitude instilled by the Army in the upper class male soldiers of the Great War. Their standing of class made them the best soldiers as they were considered superior men in society.
Pride and fear of cowardice, refrain some soldiers and veterans from asking for help. “They hide in the background and never come forward.”[71] Veterans yearn to receive a better attitude from the British Army. To be valued and appreciated for the duty they have given. If so, transition would be easier. Admitting to it and dealing with PTSD would be easier. Welsh Government has launched a scheme recently in 2023, to be more “veteran-friendly”.[72]Words need to be transformed into action.
Indeed, the TRIAD study concludes that there is an “urgent need for promoting the continuity.”[73] The British Army needs to be more active in supporting veterans with PTSD especially. Military authorities rely too much on charities to offer support. Two main ones are the Royal British Legion (RBL) and Combat Stress.
The RBL website details the symptoms and how to access support for PTSD and mental health problems. Links to NHS therapy are provided for each region. It refers to the “OPCourage scheme” set up by NHS England as an ”NHS mental health specialist service.” Treatment options, specifically for PTSD are mentioned: TF-CBT (Trauma-focused cognitive behavioural therapy) and EMDR (Eye movement desensitization and reprocessing).[74] However, differences appear between the level of information provided on the website regarding the ease of contacting for support in Wales. Once again, a lack of consistency.
Another prominent charity is “Combat Stress.” Here, is a clear explanation of PTSD offering support to veterans.
“PTSD can profoundly impact how a person can live their life, how they feel themselves.” [75]
Dr Lee Robinson, principal clinical phycologist
This same attitude needs to be expressed with more purpose and genuinely by the British Army. They should portray more clearly their duty of care for veterans as well as serving soldiers. Especially those suffering the scars of service. As Loughran concludes in her article, there is an acceptance that “war can cause suffering and that psychological pain is one constant.”[76]
Shell shock to PTSD – causes of over a century of suffering. In that period, another constant has been the British Army. But what of their attitude towards psychological disorders such as shell shock and PTSD? Have they changed?
Wessely and Jones raise the question,
“Who bears the responsibility for the consequences?”[77]
Indeed, a health issue such as PTSD among veterans needs a collaborative support system in place. Sensitive, suitable and sufficient support is required. Certainly, the British Army should be at the core of any such support. A more positive attitude from them would be beneficial, now and in the future.
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[1] King’s College London, King’s College London (2021) ‘The Evolution of Post-Traumatic Stress disorder in the UK Armed Forces: Traumatic exposures in Iraq and Afghanistan and responses of distress (TRIAD Study), King’s Centre for Military Health Research, London
[2] Wessely, S., Wessely, S. and Jones, E., Shell Shock to PTSD Military Psychiatry from 1900 to the Gulf War (Hove and New York, Psychology Press, 2005) introduction
[3] Shepherd, B., A War of Nerves: Soldiers and Psychiatrists 1914 -1944 (London, Johnathon Cape, 2000) p 1 Greenberg, N et al, p 261
[4] Loughran, T., ‘Shell Shock, Trauma and the First World War: The Making of a Diagnosis and its Histories’, Journal of the History of Medicine and Allied Sciences, 67:1 (2002) p 105
[5] Shepherd, B. p 2
[6] Shepherd, B. p 2
[7] Loughran, T. p 102
[8] Loughran, T. p 105
[9] Hynes, S., A War Imagined: The First World War and English Culture (New York, Atheneum, 1991) p xi
[10] Loughran, T. p 106
[11] Loughran, T. p 105
[12] Loughran, T. p 108
[13] Shepherd, B. p 23
[14] Shepherd, B. p 24
[15] Shepherd, B. p 25
[16] IWM, Voices of the first World War: Shell Shock, Shell Shock After The First World War | Imperial War Museums (iwm.org.uk) [Accessed 2 January 2024]
[17] IWM
[18] Biess, F. ‘Book Review of Shell Shock: Traumatic Neurosis in the British Soldiers of First World War by Peter Leese’(New York, Palgrave Macmillan, 2002), War in History, 12:3 (2005) p 354
[19] IWM
[20] IWM
[21] Black, J. A. A. , ‘Book Review of Shell Shock: Traumatic Neurosis in the British Soldiers of First World War by Peter Leese’ (New York, Palgrave Macmillan, 2002), Albion; A Quarterly Journal Concerned with British Studies, 35:4 (2003) p 699
[22] Loughran, T. p 111
[23] Wessely, S. p 125
[24] Bogacz, T., ‘War Neurosis and cultural change in England 1914-1922: The work of the War Office Committee into Shell Shock, Journal of Contemporary History, 24:2 (1989) p 235
[25] National Archives, Shell Shock Cases
[26] Bogacz, T. p 227
[27] Bogacz, T. p 236
[28] Bogacz, T. p 244
[29] Bogacz, T. p 241
[30] National Archives
[31] Bogacz, T. p 248
[32] Shepherd, B. p 18
[33] Shepherd, B. p 19
[34] Bogacz, T. p 248
[35] Shepherd, B. p 19
[36] Biess. F. p 142
[37] Shepherd, B. p 25
[38] Biess. F. p 354
[39] Biess. F. p 454
[40] Black, p 700
[41] Biess. F. p 354
[42] Wessely, S., ‘Twentieth-century theories on Combat Motivation and breakdown’, Journal of Contemporary History, 41:2 (2006) p 271
[43] Greenberg, N. et al, ‘The Injured Mind in the UK Armed Forces’, Philosophical Transactions: Biological Sciences, 366:1562 (2011) pp 262
[44] Wessely, S. p 268
[45] Shepherd p 2
[46] Jones, G Brothers in Arms (London, Macmillan, 2019) p 306
[47] Greenberg, N. et al p 262
[48] Jones, G. p 446
[49] Loughran, T. p 109
[50] Jones, G. (2020) Veteran State of Mind: From Baghdad to Breakpoint ,Available at Veteran State Of Mind Episode 038: From Baghdad to Break Point, with Dave Radband (buzzsprout.com)
[51] Jones, G. (2020)
[52] Greenberg, N. et al p 265
[53] House of Commons (2016) ‘The Report of the Iraq Enquiry, Executive Summary’, London, Her Majesty’s Stationary Office
[54]House of Commons (2016)
[55]Greenberg, N. et al p 265
[56] Office for Veteran’s Affairs (2020) ‘Veterans Factsheet’, Great Britain
[57] Office for Veteran’s Affairs (2020)
[58] BBC News, mental Health: Growing demands for veterans’ support charities warn Available at Mental health: Growing demand for veteran support, charities warn – BBC News
[59] Ministry of Defence, (2023) ’Suicide in the UK Regular Armed Forces: annual summary and trends over time, 1 January to 31 December 2022, Bristol
[60] BBC News, mental Health: Growing demands for veterans’ support charities warn Available at Mental health: Growing demand for veteran support, charities warn – BBC News
[61] Sprenger, R., (2018) ‘Fight or Flight: the veterans at war with PTSD’, The Guardian 8 November 2018, Available at Fight or flight: the veterans at war with PTSD – video | UK news | The Guardian
[62] The British Army, (2018) ‘This is Belonging Keeping Faith’ Available at https://youtu.be/OQ4OoPNY_YM
[63] Sprenger, R., (2018)
[64] King’s College London, King’s College London (2021) ‘The Evolution of Post-Traumatic Stress disorder in the UK Armed Forces: Traumatic exposures in Iraq and Afghanistan and responses of distress (TRIAD Study), King’s Centre for Military Health Research, London
[65] The British Army, (2018) ‘Values and Standards of the British Army’, Hampshire p 26
[66] The British Army p 30
[67] The British Army p 18
[68] The British Army p 17
[69] The British Army, (2018) ‘Values and Standards of the British Army’, Hampshire p 19
[70] Jones G., p 268
[71] BBC News, mental Health: Growing demands for veterans’ support charities warn Available at Mental health: Growing demand for veteran support, charities warn – BBC News
[72] BBC News, mental Health: Growing demands for veterans’ support charities warn Available at Mental health: Growing demand for veteran support, charities warn – BBC News
[73] King’s College London, p 58
[74] Royal British Legion, (2024) Post-traumatic stress disorder; Available at RBL – Post-Traumatic Stress Disorder (PTSD) (britishlegion.org.uk)
[75] Combat Stress, (2024) What is PTSD? Available at What is PTSD? | Combat Stress
[76] Loughran, T. p 114
[77] Wessely, S. and Jones, E. p 127