Wounded in Action
The first symptom was sleeplessness. It was July 2003 and Lance Corporal David McGough of the Royal Army Medical Corps was just back from a five-month tour of duty in Basra, Iraq. Lots of the lads from his unit had trouble settling back to a normal routine at first, but most were OK within a fortnight or so. David, however, did not sleep for an entire month.
“My body just wouldn’t switch off,” he tells me, fidgeting with his hands. “All the time this tension was building, this incredibly tense restlessness. I was going for weeks without any sleep at all and then collapsing, sleeping for maybe six hours, and then starting all over again.” At night, on leave, he walked around his small maisonette in a suburb of Preston, Lancashire, folding and re-folding his clothes, checking and double-checking the locks, looking over his shoulder repeatedly for imagined intruders.
McGough was vomiting every day, often bloodily. The odour of cooking or burned meat made him sick, though “the worst thing is the smell of public toilets”. “That brings the PoW camps back. The stench of those places was horrendous.”
Mostly it was the insomnia that started to drive him mad, that made him crash his car and almost beat his then-fiancee, that both masked and exacerbated his chronic underlying depression. The army doctor at the camp in Preston prescribed him Prozac and more or less told him to pull himself together. When Prozac failed to work, McGough was given a stronger antidepressant, citalopram, “but no sleeping tablets, and by then – Christmas – I wasn’t really sleeping at all”.
McGough’s two attempts at suicide, both at Christmas in 2003, were more cries for help than committed bids to kill himself. On the first occasion he held a knife across his throat until his sister begged him to put it down, and on the second he put a 9mm pistol to his head but did not pull the trigger fully. Horrified by what was happening, McGough’s father, a civil servant based in Northern Ireland, called Dr Alun Jones, a civilian psychiatrist who specialises in diagnosing and treating psychological problems in servicemen and women. “It was immediately clear,” says Jones, “that McGough was suffering a severe case of post-traumatic stress disorder.”
So far, PTSD experts have seen a mere handful of British sufferers from this latest war in Iraq – but as the violence goes on, the trickle is expected to become a flood. Late last year, the independent inquiry into Gulf war illnesses chaired by Lord Lloyd of Berwick came to the conclusion that there was “every reason” to accept the existence of a Gulf war syndrome, and that post-traumatic stress was one of several contributing factors. Though the Ministry of Defence does not publish statistical predictions, military psychiatrists in America have been warned to expect psychiatric disorder to occur in a remarkable 20% of servicemen and women returning from Iraq.
“What we’ve got now is a situation starting to approximate to Northern Ireland or Bosnia, to civil insurrection rather than a straight shooting war,” says Jones, who runs PTSD clinics around the country and at a residential centre in north Wales.”In those kinds of circumstances, where you’re experiencing hatred and violence from an unpredictable civilian population, we tend to get a lot of very disturbed and damaged soldiers.” In the field of trauma studies, this atmosphere of constant and random danger is known by the shorthand “no safe place”.
Other surveys suggest that roughly half the servicemen who suffer psychiatric illness as a result of traumatic events do not seek medical help, or do so years later, when the psychological afterburn has irreparably damaged marriages, careers and mental wellbeing. “And there’s still a stigma attached,” says Leigh Skelton, director of clinical services at Combat Stress, the ex-services mental welfare charity. “PTSD is seen as a career-stopper within the army. Generally, the first line of action servicemen and women take is to bottle it up. Then they’ll self-medicate, usually with alcohol, sometimes with other substances. Cries for help often come from relatives rather than from the affected person.”
Symptoms range from insomnia, nausea and extreme fatigue to the classic “flashback”; aggression, feelings of alienation and irrational anger. Sometimes the disorder centres on one particular memory. A 30-year-old female ambulance driver in the Territorial Army, for example, constantly replays the moment her vehicle was blown up last year by a hand-made bomb tied to a lamp-post in Basra. One marine in his early 20s now suffering chronic PTSD remembers “the fear in the eyes of an Iraqi soldier in the window” of a building mortared by the British; and seeing that fear again when British soldiers mistakenly opened fire on a civilian vehicle.
McGough, however, identified no single trigger. Skinny and pale, when I met him in late November he was a shadow of the strong young man he was pre-Iraq – the high-flyer who studied psychology at Queen’s College, Belfast, who loved to sky-dive and socialise, who was promoted within a year of joining the RAMC. For him, the pressure began the moment he and his medical unit moved into Iraq, at 2.30am on the first night of the war, four hours after the Americans began their aerial bombardment of Baghdad.
McGough was 21 years old and effectively in charge of 80 rookie soldiers fresh out of training, most of them still teenagers. As medics, they travelled in canvas-roofed trucks and were not equipped with body armour. “There was gunfire everywhere. Some of them were literally crapping themselves in the back of those trucks.” That first night, there wasn’t even time to pitch camp. “The worst casualty I saw was an Iraqi guy hit about 13 times, big chunks of his stomach, face and legs just gone. We intubated him and opened him up by the side of a truck. You do it on autopilot at the time because your training kicks in. It’s only afterwards you start to think about what you’ve seen and done.”
The mobile field unit, the first line of medical services, was initially established just south of Basra, but was twice relocated to escape attack. Its job was to mop up trauma cases, stabilise them and send them to field hospitals nearer the southern border. According to McGough, the medical unit received up to 1,000 wounded Iraqis during his five-and-a-half-month tour of duty, of whom perhaps 60% died and were buried in mass graves.
A large proportion of the medics’ work, however, took place in the PoW camps set up on each site. “Usually we had about 150 prisoners coming in a day,” says McGough, “both soldiers and civilians who’d been picked up with guns. Some had clearly been tortured by the Iraqi regime. There was one man who had thick black stuff, like goo, coming out of his penis, and said he’d been injected with something when he was a prisoner before. Others had quite infected lash wounds on their backs, or broken jaw bones.” The unit also saw a number of raped women, who were treated and counselled by a female army gynaecologist.
Seemingly futile or absurd situations are known to compound wartime trauma. The unit’s first location at Basra was regularly attacked by Iraqis defending a nearby ammunition dump from a maze-like system of trenches. “There was no adherence to any kind of convention on their part. Sometimes it was ridiculous. Every time we hit and wounded someone, a white flag would go up on their side and the others would bring the man we’d wounded over to the base for treatment. Then they’d go back up and start shooting at us again.”
Most harrowing of all was the discovery of the corpse of a 12-year-old girl who’d been hanged in a backstreet alley in Basra. McGough was sent to confirm the death and recognised her as the child to whom he and his comrades had chatted the week before. “We heard later that she was probably hanged by the crowd because she’d been talking to our crew … That was one of the worst things. You expect to see some nasty stuff, but seeing a little girl hanging in the street because she once spoke to you … ”
PTSD has been a recognised injury of war for more than 30 years, yet treatment in Britain is still very patchy. It took complete break-down (“my girlfriend found me one night huddled on the floor, shaking and crying”) and several emergency trips to hospital in Preston before McGough was finally prescribed sleeping tablets. While a member of the British army, he was unable to access the civilian care system – and had been informed of a decision to discharge him without a pension.
“The army is not a branch of the social services,” says Jones, “but I do think there is a certain duty of care, knowing what we now know about the effects of trauma. It would be reasonable to expect the army to check these lads over for psychological injury when they come back from combat, but in fact there is no obligation whatsoever to do this.”
“No one rings or visits in the mornings because I’m just a horrible, nasty person before the drugs have kicked in,” says McGough. He was increasingly convinced that his physical symptoms – the vomiting and chronic weight loss – are related to anthrax injections and to the Naps tablets taken to counter the potential use of enemy nerve agents. On bad days he does not get out of bed at all.
“I loved being in the army,” he says. “It was supposed to be my long-term career, and I was prepared to give everything to it … I just wish I could shake this and get on with my life again.”