There are many pressing and ongoing concerns following the latest Gulf war. The intense media focus on Iraq during the military invasion has quietened down after ‘our troops’ returned home, supposedly victorious over the ‘axes of evil’. We won’t know for many years the full extent of casualties, or the environmental, cultural and economic consequences of the war. There are concerns about the continued occupation of Iraq; the imposition of a US led corporate ‘democracy’; the incursion of western imperialism and the fight for economic power through access to oil and dominance over global markets. It is nonsense to even ask if anyone has ‘won’ in the midst of the catastrophe that has been unleashed on the middle- east.
Leaving these concerns aside, there are other questions that need consideration. It is doubtful whether the allied forces will ever ‘win the hearts and minds’ of the Iraqi people, but there is another battle being fought, that of the definition and treatment of the mental distress that is inevitably produced by war. We do not know if psychiatry will emerge as a ‘winner’ in this battle over the bodies and minds of those physically and emotionally effected by the invasion. All the propaganda about finding weapons of mass destruction has led critics to suggest that the media has become a weapon of mass distraction during the war. In a similar way we can question the role of psychiatry during war. Is it a weapon of delusion or a weapon against delusion? And finally, what should be the response of a radical democratic psychiatry?
Psychiatric Consequences of War
One of the immediate consequences of the attack on Iraq was to render many of its hospitals unworkable and unsafe. During the war hospitals became the targets of looters and attacks against women and sexual assaults increased. Psychiatric hospitals and patients were not exempt from these attacks. The bombing of Baghdad resulted in a mass exodus of patients and staff from hospitals and consequently the looting of Rashad Psychiatric hospital in North East Baghdad. The International Committee of the Red Cross reported that many patients were subsequently attacked and some raped. Many of these patients had been hospitalised as a consequence of their experiences of the previous gulf war in 1991.
It is clear that the emotional after-effects of war can be severe. We know little about the long-term effects on soldiers and even less about effects on civilians. However, what we do know is that in the UK many organisations have estimated that about a quarter of all homeless people have served in the military forces and over 5,000 ex service men and women are in prison. The Ministry of Defence’s own figures from the 1991 Gulf war, record that nearly five times as many service personnel killed themselves as died in combat. The National Gulf Veterans and families Association claim that 70% of service men who died since 1991 committed suicide. Ironically, the anti war movement was chastised for not supporting ‘our troops’, yet UK health ministers have made it clear that there will be no extra resources for any specialist mental health support following the latest Gulf war. There seems to be a strong case for more mental health support and the increased use of psychiatry to intervene in the aftermath of war. However, although greater support and resources is necessary, the role of psychiatry in such circumstances is not always straightforward.
Gulf War Syndrome and Chemical Poisoning
Despite the lack of mental health support for war veterans, psychiatry frequently plays a mediating role between the Government, the military and the population effected by war. The role of psychiatry in the aftermath of war is a complex and conflictual one. The obvious place to explore this complexity is in the debates about ‘Gulf War Syndrome’. This medical-psychiatric diagnosis emerged following the last gulf war in 1991. The Ministry of Defence has contested both the existence and the causes of Gulf War Syndrome. Yet, many former gulf war veterans have claimed that they are suffering from a specific condition arising from their action in the Gulf, which is not simply a post trauma reaction. The US Department of Defence have also refused to recognise its existence. They advise military doctors to treat any symptoms not clearly related to military combat as Post -Traumatic Stress Disorder. Because the experience of Gulf War Syndrome includes a variety of physiological complaints this is effectively drawing upon the old diagnosis of ‘hysteria’ whereby psychological difficulties are experienced as if they were physical ones. Doctors often order an assessment for mental illness and usually treat the symptoms with a variety of drugs including muscle relaxants and sleeping pills. The emotional trauma of war is hard enough for Governments to accept, yet there are other possible factors in Gulf War Syndrome which the Department of Defence is even less inclined to reveal. The most important of which is the effect of Depleted Uranium which was used for the first time on a wide scale in the 1991 Gulf War.
Another contributing factor to the experience of Gulf War Syndrome may be the extensive use of pesticides and insecticides in army base camps. These chemicals are known to be carcinogenic and may play a role in the development of M.E. and Chronic Fatigue. Combination vaccinations are also given to soldiers as protection against nerve and biological warfare agents and soldiers may have been affected by chemical and smoke pollution caused by burning oil wells or electromagnetic radiation from the use of radar devices. The only contributory factor to the poor health of veterans that the US Department of Defence has openly acknowledged in the 1991 Gulf War was the allied force’s destruction of Iraq’s chemical, nerve and biological weapons resulting in widespread spread of toxins. They have focused on this as the only possible external cause, thereby in effect, blaming Iraq.
In the absence of any discovery of Iraqi weapons of mass destruction in the latest conflict, where can the US and UK administrations place the blame as the consequences of this war emerge? Even The US State Department’s generous offer of a million dollars to anyone who might be able to ‘find’ any such weapons has yet to throw up any ‘evidence’. On the subject of weapons of mass destruction, it is important to note that the use of depleted uranium is considered to cause wide scale and long term damage. Depleted Uranium is a by-product of the manufacture of nuclear weapons and wherever it has been used will remain radioactive for about 4.5 billion years. It can be inhaled, enter the food chain, contaminate water and is likely to remain in human organs for many years. It can cause cancer, leukaemia, kidney damage, neuro-cognitive problems, birth defects and many other difficulties. The wide spread use of Depleted Uranium in the last Gulf War effectively made it a nuclear war. The health effects of exposure to Depleted Uranium were already known before the war, but it was used anyway. It has then used in Bosnia during the 1990’s and more recently in Kosovo and Serbia in 1999, the same year that a UN sub-commission called for the use of Depleted Uranium to be banned world-wide. This ban was blocked, primarily by the US administration, just as they have refused to recognise the International Criminal Court (recognition of which might have led to an international criminal investigation into the legality of the invasion of Iraq). We know Depleted Uranium has been used in the latest Gulf War, but its extent is a well kept secret.
Depleted Uranium may not in itself be the sole cause of the experience of Gulf War Syndrome. However, it seems clear that the intensive and wide scale use of chemical poisons and radiation in war can cause profound and lasting physiological and psychological damage. When Christine Gosden visited the survivors of Iraq’s chemical attack on the Kurdish town of Halabja in 1998, ten years after the attack, she found that many were suffering very similar health problems as war veterans in the gulf.
Psychiatry: A Weapon of Delusion?
What has this to do with psychiatry? The Pentagon is still playing down their use of Depleted Uranium and the effects of chemicals, poisons and radiation used in the Gulf wars. Apologists for the nuclear industry claim that there are no observable health effects that can be attributed to it. On occasion, they have even argued that contact with low does of toxicity and radiation from Depleted Uranium might be actually be beneficial to people. Psychiatry has often been used to discredit people when they have become suspicious of these claims. For example, Clint Jensen worked for Bechtel at an engineering laboratory, where they develop Depleted Uranium to use in Army tanks. He raised concerns about the safety conditions at the factory and the experience of symptoms similar to that of Gulf War Syndrome amongst his fellow workers. His employer, Bechtel attempted to silence him by, amongst other means, referring him repeatedly to psychiatrists. However, recent independent research in the UK suggests that many Gulf War veterans are suffering from brain and neurological damage caused by toxic exposure to Depleted Uranium. However, this has not prevented its continued use. Some have suggested that psychiatry has directly benefited from this ongoing denial or ‘cover up’. The classification of effects of the war as a psychiatric problem essentially labels it an individual problem and ensures that it is individuals and their families who pay for the damage. It is worth noting that it is companies such as Bechtel who are directly benefiting from receiving contracts for the ‘rebuilding’ of Iraq following the invasion.
It is easier and cheaper if psychiatrists, wedded to drug companies, treat people as suffering from a individual illness rather than face up to massive financial liabilities if the US Military, the Government and the Nuclear Industry were considered culpable. In the same way that US corporations have stitched up the major contracts and deals in the reconstruction of Iraq, so the drug companies can gain their own share of the market following the destruction of the bodies, hearts and minds of men and women serving in the Gulf.
Psychiatry: A Weapon against Delusion?
But, this isn’t the whole story. It is clear that there are vested interests at play in maintaining the status of ‘Gulf War Syndrome’ as a psychiatric disorder. However, Elaine Showalter, in Hystories: Hysterical Epidemics and Modern Media, has argued that there is a problem of machismo in pleas for the recognition of Gulf War Syndrome. There is also a profound stigma associated with the diagnosis of ‘mental illness’. Many veterans and their families have strong negative reactions to any suggestion that they many be suffering from mental health difficulties. Showalter argues that thousands of men and women subsequently deny themselves therapy because they are encouraged to look for medical causes and pursue legal cases. The idea that people may be suffering, not from toxic poisoning, or battle wounds, but ‘just’ a human response to mass suffering, killing and trauma may be too hard to stomach. The idea of experiencing mental distress or trauma can be too readily viewed as weak or wimpish. However, Showalter claims that war veterans are wasting their time looking for chemical causes of their distress and illness and should seek help at the hands of psychotherapists. She even suggests that they are suffering from a ‘plague of paranoia’ because they insist on a high level Government cover-up. Showalter’s attempts to highlight the ‘moral panics’ of our century are laudable, but in denying the lived experience of veterans she does herself a disservice. Children born with extraordinary birth defects, congenital deformities, cancers and leukaemia, all found to be linked to contact with chemicals used in war, cannot be put down to trauma. However, this does not, and should not, minimise the effects of trauma itself, as that would also be culpable.
A radical democratic psychiatry should oppose war and be critical of the role of psychiatry, and the drug companies, both during and after war. Both psychiatry and the corporate drug companies have colluded with the silence around Depleted Uranium and other chemical toxins used in war. They have contributed to the silencing and blaming of individuals for the wider impact of war and patched people up to send them back to fight in dubious causes. However, critical practitioners also need to respond sensitively in the aftermath of war. Here psychiatric diagnosis is insufficient and actually evades the crucial problems. It need not be an either/or cause or solution that is suggested by Showalter or the Gulf war veterans. The Gulf war is causing widespread chemical destruction, the true effects and extent to which we are yet to see. It also causes massive ongoing emotional and psychological damage. The real treatment in both cases is neither compensation, psychiatric drugs, nor psychotherapy. More important perhaps is to increase our awareness of, and opposition to, the use of chemical and biological agents such as Depleted Uranium. The distress and illness caused by war are real and affects individuals, yet ultimately the only solution is to prevent war itself, something which can only be a collective enterprise.
For more Information about Depleted Uranium see the Campaign against Depleted Uranium at http//:www.cadu.org.uk