Skip to main content

Risk, psychiatry and the military

  • Simon Wessely (a1)

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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Risk, psychiatry and the military
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Risk, psychiatry and the military
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Risk, psychiatry and the military
      Available formats
Hide All
Aceves-Avila, F., Ferrari, R. & Ramos-Remus, C. (2004) New insights into culture driven disorders. Best Practice and Research in Clinical Rheumatology, 18, 155171.
Aita, J. (1949) Efficacy of brief clinical interview method in predicting adjustment: 5 year follow-up study of 304 Army inductees. Archives of Neurology and Psychiatry, 61, 170178.
Artiss, K. L. (1997) Combat psychiatry: from history to theory. Military Medicine, 162, 605609.
Barrett, D., Gray, G., Doebbeling, B., et al (2003) Frevalence of symptoms and symptom-based conditions among Gulf War veterans: current status of research findings. Epidemiologic Reviews, 24, 218227.
Barsky, A. (1988) The paradox of health. New England Journal of Medicine, 318, 414418.
Beck, U. (1992) Risk Society: Towards a New Modernity (trans. Ritter, M.). London: Sage.
Belenky, G. L. (1987) Varieties of reaction and adaptation to combat experience. Bulletin of the Menninger Clinic, 51, 6479.
Belenky, G. L., Noy, S. & Solomon, Z. (1985) Battle Stress. Military Review, 2937.
Bey, W. (1970) Division psychiatry in Vietnam. American Journal of Psychiatry, 127, 146150.
Bourke, J. (1999) An Intimate History of Killing. London: Granta.
Bourne, P. (1970) Military psychiatry and the Vietnam experience. American Journal of Psychiatry, 127, 481488.
Brewin, C., Andrews, B. & Valentine, J. (2000) Meta-analysis of risk factors for posttraumatic stress disorder in trauma exposed adults. Journal of Consulting and Clinical Psychology, 68, 748766.
Carson, R. (1962) Silent Spring. Reprinted 2000. Harmondsworth: Penguin.
Chalder, T., Hotopf, M., Hull, L., et al (2001) Prevalence of Gulf war veterans who believe they have Gulf war syndrome: questionnaire study. BMJ, 323, 473476.
Cherry, N., Creed, F., Silman, A., et al (2001) Health and exposures of United Kingdom Gulf war veterans. Part 1: The pattern and extent of ill health. Occupational and Environmental Medicine, 58, 291298.
Dalrymple, T. (1998) Mass Listeria: The Meaning of Health Scares. London: Deutsch.
Dandeker, C. (2001) On the need to be different: military uniqueness and civil–military relations in modern society. RUSI Journal, 146, 49.
De Groot, G. (2000) A Noble Cause? America and the Vietnam War. Harlow: Longman.
Durodie, W. & Wessely, S. (2002) Resilience or panic: the public's response to a terrorist attack. Lancet, 360, 19011902.
Emmerik, A., Kamphuls, J., Hulsbosch, A., et al (2002) Single session debriefing after psychological trauma: a meta analysis. Lancet, 360, 736741.
Fulco, C., Liverman, C. & Sox, H. (eds) (2000) Gulf War and Health. Vol. I: Depleted Uranium, Sarin, Pyridostigmine Bromide, Vaccines. Washington, DC: Institute of Medicine.
Furedi, F. (2003) Therapy Culture: Cultivating Vulnerability in an Anxious Age. London: Routledge.
Ginzberg, E. (1959) The Lost Divisions. New York: Columbia University Press.
Gist, R. (2002) What have they done to my song? Social science, social movements and the debriefing debates. Cognitive and Behavioral Practice, 9, 273279.
Glass, A. (1974) Mental health programs in the Armed Forces. In American Handbook of Psychiatry (ed. Caplan, G.), pp. 800809. New York: Basic Books.
Glass, T. & Schoch-Spana, M. (2002) Bioterrorism and the people: how to vaccinate a city against panic. Clinical Infectious Diseases, 34, 217223.
Harrison, T. & Clarke, D. (1992) The Northfield experiments. British Journal of Psychiatry, 160, 698708.
Independent Expert Group on Mobkle Phones (2000) Mobile Phones and Health. London: IEGMP.
Ismail, K., Kent, K., Brugha, T., et al (2002) The mental health of UK Gulf war veterans: phase 2 of two-phase cohort study. BMJ, 325, 576579.
Iversen, A., Dyson, C., Smith, N., et al (2005) ‘Goodbye and good luck’; the mental health needs and treatment experiences of British ex-service personnel. British Journal of Psychiatry, 186, 480486.
Johnson, A. (2004) Long-term course of treatment-seeking veterans with posttraumatic stress disorder. Journal of Nervous and Mental Diseases, 192, 3541.
Jones, E. & Wessely, S. (2001) Psychiatric battle casualties: an intra- and inter-war comparison. British Journal of Psychiatry, 178, 242247.
Jones, E., Palmer, I. & Wessely, S. (2002) War Fensions (1900–1945): changing models of psychological understanding. British Journal of Psychiatry, 180, 374379.
Jones, E., Hyams, K. & Wessely, S. (2003) Screening for vulnerability to psychological disorders in the military: an historical inquiry. Journal of Medical Screening, 10, 4046.
Jones, E., Woolven, R., Durodie, W., et al (2004) Public panic and morale: are assessment of civilian reactions during the Blitz and World War 2. Journal of Social History, 17, 463479.
Jones, N., Roberts, P. & Greenberg, N. (2003) Peer-group risk assessment: a post-traumatic management strategy for hierarchical organizations. Occupational Medicine, 53, 469475.
Lee, K., Vaillant, G., Torrey, W., et al (1995) A 50-year prospective study of the psychological sequelae of World War II combat. American Journal of Psychiatry, 152, 516522.
Palmer, I. (2003) The emotion that dare not speak its name? British Army Review, 132, 3137.
Petrie, K. & Wessely, S. (2002) Modern worries and medicine. BMJ, 324, 690691.
Petrie, K., Broadbent, E., Kley, N., et al (2005) Worries about modernity predict symptom complaints following environmental spraying. Psychosomatic Medicine, in press.
Roht, L., Vernon, S., Weir, F., et al (1985) Community exposure to hazardous waste disposal sites: assessing reporting bias. American Journal of Epidemiology, 122, 418433.
Rona, R., Hooper, R., Jones, M., et al (2004) Screening for physical and psychological illness in the British Armed Forces: III The value of a questionnaire to assist a Medical Officer to decide who needs help. Journal of Medical Screening, 11, 158163.
Scott, J. (1993) The Politics of Readjustment: Vietnam Veterans Since the War. New York: DeGruyter.
Shephard, B. (2000) A War of Nerves: Soldiers and Psychiatrists I9I4–I994. London: Cape.
Shils, E. & Janowitz, M. (1948) Cohesion and disintegration in the Wehrmacht in World War II. Public Opinion Quarterly, 12, 280315.
Shorter, E. (1992) From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era. New York: Free Press.
Skolbekken, J. (1995) The risk epidemic in medical journals. Social Science and Medicine, 40, 291305.
Slovic, P. (1999) Trust, emotion, sex, politics, and science: surveying the risk assessment battlefield. Risk Analysis, 19, 689702.
Solomon, Z. (1989) A 3-year prospective study of post-traumatic stress disorder in Israeli combat veterans. Journal of Traumatic Stress, 2, 5973.
Turner, M. A., Kiernan, M. D., McKechanie, A., et al (2005) Acute military psychiatric casualties from the war in Iraq. British Journal of Psychiatry, 186, 476479.
Unwin, C., Blatchley, N., Coker, W., et al (1999) The health of United Kingdom servicemen who served in the Persian Gulf War. Lancet, 353, 169178.
Verbrugge, L. (1984) Longer life but worsening health? Trends in health and mortality of middle aged and older persons. Millbank Memorial Fund Quarterly, 62, 475519.
Warwick, H. M. & Salkovskis, P. M. (1985) Reassurance. BMJ, 290, 1028.
Wessely, S. (2001) Ten years on, what do we know about the Gulf War syndrome? Clinical Medicine (JRCPL), 1, 2837.
Wessely, S. & Deahl, M. (2003) Psychological debriefing is a waste of time. British Journal of Psychiatry, 183, 1214.
Wessely, S. & Jones, E. (2004) Psychiatry and the lessons of Vietnam: what were they and are they still relevant? War and Society, 22, 89103.
Multiple Claimants v. The Ministry of Defence [2003] EWHC 1134 (QB).
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Risk, psychiatry and the military

  • Simon Wessely (a1)
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *