Feature: When the war is over

Scientia Professor Richard Bryant
Tuesday, 8 October, 2013
Jonathan Pearlman
The Australian military is preparing for a battle at home as the mental toll of Australia's commitment in Afghanistan impacts on returning troops, although it will not be as bad as after Vietnam.
Just six weeks into his first tour of duty in Afghanistan, Private Paul Warren was patrolling only metres away from a fellow soldier who stepped on a pressure-activated improvised explosive device (IED).
That soldier was Warren’s friend, 22-year-old Private Benjamin Ranaudo. Renaudo died; Warren was rescued, but later had his right leg amputated.
Back in Australia, rehabilitation began at a hospital in Brisbane. It was only months later at home with his partner in Townsville, that Warren began to suffer post-traumatic stress disorder (PTSD).
“The physical injury was a constant reminder that one of your mates was killed,” says Warren of his return to ‘normal life’. “I had five months in hospital learning to walk again. That part was all right because you always had goals to achieve. When I got home and all my mates were overseas, you realise life is a bit different.
“You could be in the middle of a conversation and your mind takes you somewhere else and it is like you are getting blown up again. It is pretty hard to get it out of your head. That goes on for ages. There didn’t have to be something to trigger it. It was just constantly there.”
More than 27,500 Australian soldiers have served in Afghanistan since 2001, including 40 who have died. The war has been Australia’s most intensive commitment since Vietnam – but, unlike Vietnam, it was conducted in the knowledge that many of the soldiers, even those who escaped physical injuries, would not return home unscathed.
So far 780 troops have presented to medical boards for assessment for PTSD, according to a defence spokeswoman.
“Army members made up about 76% of these, navy 15% and air force 9%,” she says.
The figures suggest that as Australia prepares to end its decade-plus commitment in Afghanistan, the military is set to face an ongoing battle at home.
While the number of veterans with PTSD is being tallied, across Australia, hundreds, probably thousands, will also suffer anxiety, depression and substance abuse.
Most of the 1600-odd servicemen and women in Oruzgan, a poor, rural region of central Afghanistan, will be back in Australia by the end of the year.
According to Richard Bryant, a Scientia Professor in UNSW’s School of Psychology, the Australian Defence Force (ADF) has been careful to avoid a repeat of Vietnam. One of the world’s leading experts in PTSD, he dismisses claims by a former commander of Australian forces in Afghanistan, Major General John Cantwell, that the military is facing a “tsunami” of trauma-related injuries.
“We will not have a repeat of Vietnam because now the ADF knows what it is dealing with,” Bryant says. “Back then you could be in Vietnam and two days later you could be in a supermarket in your local town and still be expecting snipers to be shooting at you. And we wondered why these people were jumpy and edgy.”
But researchers are still trying to grapple with the best ways to deal with post deployment mental health problems.
Figures released by the ADF have shown that while rates of PTSD are high – about 8% or double that of the non-military population – the prevalence is not necessarily linked to deployment. This tallies with research showing it’s not serving in war that is the problem but soldiers’ direct exposure to combat.
“Lots of people who go on deployment do not get exposed to anything nasty,” says Bryant. “What we do know will predict PTSD is the extent to which troops are exposed directly to death or injury. For those dealing with the IEDs, the engineers working on detecting mines, the medics who are dealing with the medical emergencies – the risks among those groups will be higher.”
Warren, who left the army in April, says it took him about 6 to 12 months to begin to recover from his PTSD. He and his partner separated but he was eventually able to speak to her about his experiences and they reunited; they are now married and have a three-year-old daughter and a one-year-old son.
He says while counselling assisted, the ADF’s support was inadequate and relied too heavily on medication.
“The worst thing was that they put you in a platoon with injured guys and you sat around all day,” he says. “You need to be mentally stimulated. The worst thing you can do is do nothing and your mind will run away from you. It is more manageable now. You think of your mate every day but not to the point where it shuts everything down.”
Warren’s experience reflects the latest research on PTSD that shows counselling and immersing soldiers in memories of their former experiences is more effective than just medication.
Dr Katherine Mills, a senior lecturer at UNSW’s National Drug and Alcohol Research Centre, says the hardest part is getting soldiers to start treatment.
“It is a disorder characterised by avoidance,” she says. “The person is doing everything they can to avoid memories and avoid thinking about what happened to them because it is so distressing. You are asking them to go to treatment to do that very thing in order to recover from it.”
Bryant says some soldiers fear they will not be promoted or will not be allowed to redeploy if they admit to having PTSD.
“Defence is doing a lot of work to try to change the culture but it changes very slowly,” he says. “You will still get the old school saying if you have a mental health problem you are weak. It takes generations to change that.”
According to research released earlier this year, another effect of exposure to combat violence is that soldiers will be more likely to commit violent crimes when they return.
Associate Professor Kimberlie Dean, UNSW’s Chair in Forensic Mental Health, who co-authored the study while working in Britain, says the “vast majority” of returned soldiers pose no risk of harm. But the study, published in The Lancet, “points to failures in the support mechanisms for returning soldiers”, she says.
“It is a very poor outcome for those soldiers and it is a very poor outcome for the victims, who can often be family members,” she says.
“If you don’t do a good job of identifying and supporting and treating returning soldiers then some of them may end up with really poor outcomes that include violent offending. To survive in intense and especially direct combat, you need to be capable of overcoming any barriers to being aggressive or violent. That kind of experience and training has a carry-on effect in civilian life.”
Researchers are beginning to focus on improved treatments for PTSD, including trying to augment the reality of the revived memory. There have been attempts to use virtual-reality technology, while UNSW researchers are examining the impact of intense exercise, which might release neurotransmitters that could further enhance the treatment.
Bryant says while the military is aware of the risks facing returned soldiers and “is taking it very seriously”, the full effects of the wars in the Middle East will not necessarily be apparent immediately but will play out over the coming years.
“The ADF has pretty good mental health systems in place,” Bryant says.
“We know from previous conflicts the effects of being in service can arise years later … but are we going to have an epidemic? Certainly not.”
This article was first published in Uniken.