In war there are no unwounded soldiers, so the saying goes. A study of the psychological impact of combat appears to back that up. Members of the UK armed forces are significantly more likely than civilians to commit a violent offence during their lifetime ? and the risk for those who have experienced action on the battlefield is 53 per cent higher than for military personnel with no combat experience.
The study is one of several published last week by The Lancet as part of a special report on the health consequences of the 2003-2011 Iraq war on the Iraqi population and coalition troops.
At least 116,900 Iraqi civilians died as a result of the war, the report claims, though it acknowledges that mortality estimates vary widely. Many more were injured or became ill because of the extensive damage to the country's health, water treatment and food production infrastructure.
Even now, the death toll continues to rise. At least 48 people in the capital Baghdad died in a series of car bombs today, apparently detonated to mark the 10th anniversary of the initial invasion of Iraq.
Violence link
The link between combat experience and later violent behaviour comes from a study by Deirdre MacManus at King's College London and her colleagues, who surveyed nearly 14,000 serving and former soldiers. The team controlled for the fact that the armed services, and front-line regiments in particular, are more likely to attract and recruit people with a history of violence.
The result is likely to set alarm bells ringing within the British army's high command, which is already in the spotlight after the violent death of Iraqi prisoner Baha Mousa at the hands of UK troops in 2003, and over more recent allegations that UK soldiers tortured and killed Iraqi detainees after a firefight in Iraq in 2004.
Meanwhile, in the US there is growing concern over the number of veterans requiring treatment for post-traumatic stress disorder (PTSD), many of whom develop violent tendencies. In a 2012 survey of 1390 US veterans who had served in Iraq and Afghanistan, one-third admitted committing an act of aggression during the previous year.
Why do battlefield experiences cause soldiers to behave more violently? MacManus says one reason is that life-threatening incidents can trigger mental health problems such as alcohol misuse and PTSD. Since PTSD is often associated with hyper-arousal, "it's understandable how someone with PTSD should react more impulsively or in an aggressive fashion", she says.
Moral injury
Another trigger is "moral injury": trauma that arises from doing something, such as killing someone, that transgresses deeply held moral beliefs. "[This] can be just as traumatising as coming under fire," says MacManus.
David Forbes, director of the Australian Centre for Posttraumatic Mental Health at the University of Melbourne, says being forced to violate core moral ideas causes soldiers to feel shame, guilt and anger. This can result in violent and antisocial behaviour on returning home.
Moral injury requires specific psychological treatment, says Forbes, to both reduce the distress of the traumatic memory and change the soldier's perception of what they have done.
Journal reference: The Lancet, doi.org/ktw
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