Risk, psychiatry and the military

The relationship between combat and psychiatric breakdown has been well recognised for decades. The change to smaller, professional armed forces has reduced the risk of large-scale acute psychiatric casualties, and should have led to a corresponding decrease in long-term ill health, but this expecte...

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Bibliographic Details
Published in:British journal of psychiatry 2005-06, Vol.186 (6), p.459-466
Main Author: Wessely, Simon
Format: Article
Language:English
Subjects:
Acute Disease
Armed forces
Aversion
Chronic Disease
Clinical assessment
Combat Disorders - prevention & control
Combat Disorders - psychology
Debriefing
Deployment
Gulf War
Gulf War syndrome
Humans
Injuries
Long term
Medical screening
Mental disorders
Military personnel
Military Personnel - psychology
Military Psychiatry
Persian Gulf War
Post traumatic stress disorder
Prominence
Psychiatric disorders
Psychiatry
Public health
Resilience
Risk
Risk aversion
Risk Factors
Risk management
Risk reduction
Society
Special Paper
Stress Disorders, Post-Traumatic - psychology
Trauma
Vietnam Conflict
Vietnam War
Warfare
World War II
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Summary:The relationship between combat and psychiatric breakdown has been well recognised for decades. The change to smaller, professional armed forces has reduced the risk of large-scale acute psychiatric casualties, and should have led to a corresponding decrease in long-term ill health, but this expected reduction seems not to have happened. Likewise, attempts at preventing psychiatric injury, by screening before deployment or debriefing after, have been disappointing. Three reasons for this are proposed: a rethinking of the relationship between trauma and long-term outcome, catalysed by the attempts of US society to come to terms with the Vietnam conflict; a broadening of the scope of psychiatric injury as it moved to the civilian sector; and the increased prominence of unexplained syndromes and contested diagnoses such as Gulf War syndrome. Traditional psychiatric injury is predictable, proportionate and can, in theory, be managed. These newer forms of injury are in contrast unanticipated, paradoxical, ill understood and hard to manage. Traditional approaches to risk management by reducing exposure have not been successful, and may increase risk aversion and reduce resilience. However, the experiences of civilians in wartime or the military show that people are not intrinsically risk-averse, provided they can see purpose in accepting risk.
ISSN:0007-1250
1472-1465
DOI:10.1192/bjp.186.6.459