There are many excellent texts available for anyone wanting to understand and manage psychological trauma. Many however, are overly reductionist: post-traumatic stress disorder (PTSD) is, more than most, a disorder that must be understood, diagnosed and managed in context, using a phenomenological approach.
Against this background, When the War Never Ends provides a refreshing contrast to much of the trauma literature. Each self-contained chapter is the personal narrative of an ex-serviceman or their carer describing the mental torture that is PTSD, together with the tragically predictable list of secondary sequelae, including substance misuse, delinquency, violence, occupational and social alienation, and collapse. Anyone wanting to understand what it is to have a ‘flashback’ will learn more from these first-hand accounts than from any textbook. The utter bewilderment and impotence of carers is another graphically illustrated theme. It is a pity no UK servicemen were included; however, PTSD is disrespectful of national boundaries and the accounts reflect those of many UK servicemen and veterans.
What this book illustrates is that there must be a holistic approach to the management of PTSD based on a strong therapeutic relationship, one that is inclusive of families and carers. Treatment currently is often disjointed between agencies and focuses on symptoms rather than their behavioural consequences. We delude ourselves about the efficacy of treatments for PTSD. In reality, they all help a bit, but even less outside of a good therapeutic relationship.
We cannot avoid service veterans, some with horrendous physical disabilities; the demographics of Iraq and Afghanistan have seen to that. There will never be sufficient specialist services and treatment must be in the mainstream. It behoves us therefore to understand and learn a little about PTSD and the particular problems facing the military, especially transitional issues around coming home from war and leaving military service, which itself is a major cause of mental health problems often mistaken for PTSD. This may seem a daunting task to colleagues who have never worn a uniform; however, for those willing to learn and make the effort this book is not a bad place to start.
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