Dr Brendan Nelson, director of the Australian War Memorial, has defended the expansion of the Memorialas a way to provide a ‘therapeutic milieu’ for veterans and their families. Critics say the obscenely large amount of $498 million is needed, not for a big expansion, but to address the unmet needs of veterans’ mental health.
Dr Nelson says that the Memorial ‘tells stories of men and women that hurt, and stories that heal’ (emphasis added). The stories the Memorial tells are inspirational and give an account of events, thus providing meaning. That is the ‘therapeutic milieu’.
It is common for veterans to suffer psychological hurt and, when the hurting meets the criteria of a mental disorder, it is often serious and complex. Without adequate therapy, however, some veterans could be further hurt by a visit to the Memorial.
Julie-Ann Finney is the mother of Petty Officer David Finney, a naval officer with 20 years’ service, who committed suicide earlier this year. She railed againstthe inadequate treatment responses to Post-Traumatic Stress Disorder (PTSD) by the Departments of Defence and Veterans’ Affairs. More recently, she has called for a Royal Commission on the veteran suicide rate in Australia and a petition to that effecthas gathered 135 000 signatures at the time of writing.
Ms Finney’s concerns are supported by the disturbing figures published by the Australian Institute of Health and Welfare in January 2018. Veterans had a significantly higher suicide rate than that of the Australian population.
Yet it was the under 30-year-old veterans’ suicide rate that was especially alarming; it was twice as high. The Mental Health Prevalence study produced by Defence and DVA in 2017showed three out of four veterans had experienced a mental disorder. High numbers of veterans reported potentially traumatic episodes (witness to atrocities, deaths and maiming) and a quarter had experienced the complex disorder of PTSD in their lifetimes. One out of five had had suicidal thoughts, suicide plans, or had attempted suicide in the previous year.
Of those surveyed, 12.6 per cent reported trauma about which they were unwilling to speak. This group had the highest rate of PTSD out of all types of specified traumatic event.
There has been in the past 50 years a wealth of research and experience in the treatment of disorders of extreme stress, especially following the return of hundreds of thousands of distressed Vietnam veterans. Traumatic memory is at the core of such disorders and is unlike any other recall of the past: it arises from witnessing horrendous events.
Often associated with the extreme event is a sense of terrible ineffectiveness. Shame and guilt are also common post-traumatic feelings, sometimes with origins in recalling the helplessness associated with the event.
Traumatic memory is not under conscious control, becoming intrusive and pervading day and night. It leads to agitation, distraction, and insomnia. There is a flood of powerful emotions. Some individuals develop numbing or even amnesia as a psychological block to such memories. And widespread use of alcohol, illicit and prescription medications helps to avoid memories and dampen emotions.
PTSD is not only associated with emotional distress, but also with a loss of belief and meaning, and the questioning of an individual’s role and life’s purpose. This may be brought on by the need to return to a civilian and domestic life that feels alien, perhaps unimportant and petty, compared with the enormity of the conflict experience, when support had come from combat camaraderie.
Some authorities have examined ‘moral injury’ as an alternative or contributing diagnosis to that of PTSD. Moral injury occurs when a combatant has been involved or witnessed an incident in which strongly held beliefs are violated. Again, shame and guilt, but especially disillusionment, are very prevalent in moral injury. As the moral philosopher Matthew Beard has stated, ‘Disillusionment is a powerful enemy to military morale’.
Treating PTSD is not a simple matter. Medication has some role, but it is limited. Exhortations to ‘get on with life’, or celebrate the service that a veteran has given, are of little use. Triggering traumatic memories, as with exposure therapy, is not favoured in the treatment of PTSD. Even telling one’s story is very much a triggering process, and is not necessary to institute therapy in the first instance.
The psychological therapies that have been most useful have highlighted the development of adaptive skills and strategies to expand life and its options, and of appropriate soothing responses to the emotional flooding that occurs with flashbacks. A sense of control can then be achieved. The past is in the past, but the memories are in the present, cannot be taken away, and require integration without their negative charge.
Maladaptive strategies, such as excess alcohol, risk taking and other self-harming behaviours often need to be addressed in the first instance. Understanding and strategies about anger may need to be taught. Recovery requires time and skilled intervention and may never be complete.
To return to whether the War Memorial can be a place of healing, many veterans have returned from conflict zones, sometimes from repeated postings to Iraq and Afghanistan. They have re-entered civilian and domestic life without insurmountable difficulty. They are not injured; they do not need healing. It can be imagined these men and women would visit the Memorial with interest.
For those with untreated or unresolved distress, especially PTSD, however, it is quite inappropriate to suggest that a visit to the Memorial is necessarily therapeutic. It is likely to be unhelpful in triggering vivid memories. To justify the expansion of the Memorial on therapeutic grounds is a further betrayal of veterans not receiving adequate clinical therapy, and of family survivors of veteran suicide. A portrayal of warfare which devalues the price that veterans and others pay will ultimately increase the risks of future Defence Force personnel suffering the same fate. Do we not owe them a duty of care to use our resources to reduce rather than increase that risk? Spending $498 million to display more of the tools of warfare does not do that.
Dr Charlotte Palmer is a retired medical practitioner, with 25 years’ clinical experience in treating psychological trauma. She is a member of Heritage Guardians, a community campaign against the War Memorial extensions and Medical Association for Prevention of War. Dr Margaret Beavis, Medical Association for Prevention of War, has also written on this subject.