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This review aimed to explore individual-level factors involved in radicalization and the impact of moral injury on an individual’s beliefs and behaviors that are relevant to radicalization. The res...

Within the past decade, the emerging field of moral injury has focused mostly on the clinical dimension of a traumatic event (Griffin et al., Journal of Traumatic Stress, 2019, 32, p. 350). This article will present a character dimension of moral injury and briefly introduce a dual pathway model of moral injury reflecting clinical and character dimensions. The investigation of the character domain borrows from the theoretical and empirical bases of moral philosophy, moral psychology, character psychology, and social psychology. Hence, this multidisciplinary understanding of moral injury encompasses: (a) moral failure, or the failure to adhere to a virtue as prescribed by a group or institution, (b) suffering or death as a direct result of moral failure, (c) unethical marking on a person's character, and (d) experience of identity negotiation between the real self and the undesired self. This character framework attempts to advance a broader theoretical foundation for moral injury that has wider applicability to the varieties of human experience, and reflects a deeper understanding of the self-concept that is not defined by and does not necessarily reflect clinical impairments.

The Blitz narrative of resilience stands in contrast to the mental health risks identified as consequences of the COVID-19 pandemic. Although evidence from then-classified studies of World War 2 showed that most people managed the stress of bombing, those vulnerable and exposed to substantial trauma had lasting or severe mental illness. Studies of different towns and occupational groups identified the proportion of people killed and wounded, the percentage of housing destroyed, and the loss of paid employment as risk factors for psychological breakdown. Mothers and children suffered not only with evacuation, but also from the trauma of bombing and damage to schools. A general association between civilian physical and psychological casualties suggests that population groups with high rates of infection and mortality might be susceptible to mental illness as a result of the pandemic. Lockdown and distancing measures contrast with the wartime sense of belonging and shared identity, reinforced by community networks and social activities.

The COVID-19 pandemic and the World War 2 aerial bombing campaign against the UK between 1939 and 1945 both exposed the civilian population to a sustained threat. Risk, whether from exposure to viral load or the density of the bombing, led to a range of protective measures and behavioural regulations being implemented. The V1 and V2 missiles used in summer and autumn, 1944, functioned as a second wave of bombing, arriving after people believed the danger had passed. Adherence to lockdown and a reluctance to return to work after the lifting of lockdown during the COVID-19 pandemic in the UK were mirrored in the preference for using home-based bomb shelters during the air raids. Heightened sensitivity to risk, or a so-called deep shelter mentality, did not materialise even during the second wave of bomb attacks and some deep bomb shelters were closed because of low occupancy. The most popular protective measures were those that reflected people's preferences, and not necessarily those that provided the greatest safety. As with the COVID-19 pandemic, the public drove government policy as much as they followed it.

Objective: Clinicians are tasked with assessing the relationship between violence and mental illness. Yet, there is now a legal expectation in some countries that public services, including health professionals, assess risk of violent extremism – with few available measures. We previously developed a new measure of Sympathies for Radicalisation, using items that measure Sympathies for Violent Protest and Terrorism. In this paper, we present the detailed psychometric properties of a reduced item measure of Sympathies for Violent Protest and Terrorism. We use data from two studies to test replication and then validity against outcomes of self-reported violence and convictions in the entire sample and in those with depressive symptoms. Methods: Data from two cross-sectional neighbourhood surveys, consisting of Pakistani and Bangladeshi adults (survey 1, n = 608) and White British and Pakistani adults (survey 2, n = 618), were used to undertake confirmatory factor analysis of Sympathies for Radicalisation and produce a short measure of Sympathies for Violent Protest and Terrorism. Survey 2 data were used to test the Sympathies for Violent Protest and Terrorism’s convergent validity to classify presence/absence of violence and convictions in the whole sample and for subgroups by depressive disorder. Results: The seven-item measure’s structure was a consistent measure of extremist attitudes across the two surveys. A threshold score of zero to classify violence was optimal (specificity = 89.7%; area under the curve = 0.75), but sensitivity to a risk of violence was poor (34.5%). The short version Sympathies for Radicalisation was a better classifier of violence in respondents with depression, dysthymia or both (area under the curve = 0.78) than respondents with neither (area under the curve = 0.69; β = 0.62, 95% confidence interval = [−0.67, 1.92]; standard error = 0.66). Conclusion: The seven-item measure of Sympathies for Violent Protest and Terrorism is an accessible and valid measure for clinical assessments and helpfully identifies low risk of violence. It enables clinicians to conduct detailed assessments of people endorsing one or more of the items, although further research is needed.

Radicalisation and extremist violence are of increasing concern internationally. The unconventional, decentralised, and transnational nature of modern terrorism involves an active process of radicalisation requiring national security responses to reflect findings from recent empirical research. This study aims to identify factors that relate to extremist attitudes and potential vulnerability to radicalisation in order to inform preventative action. A cross-sectional survey was conducted of a representative population sample of men and women aged 18–45 of Muslim heritage recruited by quota sampling in two English cities. Logistic regressions were performed on a seven-item dichotomised measure based on our previously developed scale of ‘sympathy for terrorist acts’. Scores representing ‘non-condemnation of these acts’ were deemed to represent risk for radicalisation. Thirteen respondents had a positive score on the sympathy for terrorism measure (2.4%), 39 scored zero (6.41%) and the remainder (91.4%) had a negative score representing condemnation of terrorist acts. There was a significant association between sympathy for terrorism and belonging to the local or global Muslim community, anxiety, and support for the use of defensive violence. Gender, religious identity, country of birth, belief in Sharia law, the importance of religion in life, and mosque attendance were all not associated with sympathy for terrorism. The results contribute to an understanding of the radicalisation process and have potential value in developing preventative public health interventions.

Sheep scab caused bySheep scab positive 'index' farms were initially diagnosed using a skin scrape to identifyThree positive 'index' farms were identified along with 12 contiguous properties. Positive serological responses were observed in seven of the 12 contiguous farms; four of which were treated by OP dip and three by an injectable ML product.To avoid reinfestation of treated farms, dealing with disease on contiguous properties is crucial. Through the project coordinating team, three local outbreaks of scab were dealt with in a short space of time with appropriate diagnosis and treatment being carried out. Some farmers were uncooperative and strategies such as providing additional external support and veterinary involvement might alleviate these issues in the future. This coordinated approach is recommended to veterinary surgeons in the field when dealing with scab on farm.

Morally injurious incidents may present ethical or legal quandaries, yet how military or civilian clinicians should manage such disclosures is poorly understood. Individuals who experience moral injury may be reluctant to seek help due to concerns about the legal ramifications of disclosure. Guidance on breaching patient confidentiality differs by regulatory body but also by profession, geography and context. As moral injury continues to become recognised in clinical practice, in the military and elsewhere, clarity is needed regarding best practice in managing moral injury cases and the dilemmas they present.

Arthur Hurst was a British First World War physician, best known for his films of shell shock, ‘War Neuroses'. He has often been portrayed an innovative pioneer of somewhat mysterious ‘suggestion’ techniques for functional motor disorders but also as an ambitious clinician who exaggerated the effectiveness of his treatments and failed to address psychological factors. His use of suggestion, persuasion and re-education together with occupational therapy, for chronic or severe cases of shell shock stirred controversy at the time because of the dramatic nature of some of his treatment responses and lack of outcome data. In part, this was a turf war between neurologists and psychiatrists for a dominant therapeutic model. A re-evaluation of his publications and new research into soldiers treated at Seale Hayne in Devon show that Hurst pioneered multidisciplinary and empathetic treatments for functional motor disorders with good short-term outcomes, though insufficient data survives to assess longer term outcomes.

IntroductionEvidence is growing regarding the impact of potentially morally injurious events (PMIEs) on mental health; yet how moral injury may affect an individual’s occupational and familial functioning remains poorly understood.MethodThirty male veterans who reported exposure to either traumatic or morally injurious events and 15 clinicians were recruited for semi-structured qualitative interviews.ResultsWhile many veterans experienced psychological distress postevent, those who experienced PMIEs especially reported social withdrawal and engagement in aggressive, risk-taking behaviours. This was highly distressing for family members and created a tense, volatile home and workplace environment that was difficult for others to navigate. Following PMIEs, employment could be used as a cognitive avoidance strategy or as a means to atone for transgressive acts. In cases of moral injury, clinicians considered that targeted support for spouses and accessible guidance to help children to better understand how their military parent may be feeling would be beneficial.ConclusionsThis study provides some of the first evidence of the pervasive negative impact of PMIEs on veterans’ familial and occupational functioning. These findings highlight the need to comprehensively screen for the impact of moral injury on daily functioning in future studies that goes beyond just an assessment of psychological symptoms.

This study explored the experiences of clinicians in providing treatment in cases of military-related moral injury (MI). Qualitative interviews were carried out with 15 clinicians. Clinicians found patients experienced particular maladaptive appraisals following MI, which were considered different from the responses experienced after threat-based trauma. To address MI-related distress, clinicians utilized a range of treatment approaches. Several difficulties in providing care to patients following MI were described, including the impact of providing treatment on the clinicians own mental health. This study provides detailed insight into the approaches currently used to identify and treat UK Veterans with MI-related psychological problems. These findings highlight the need to evaluate the effectiveness of the treatments currently provided for MI-related psychological problems and suggest developing best practice guidance may improve clinician confidence in delivering care to those adversely impacted by MI.

The British Mandate in Palestine ended abruptly in 1948. The British departure engendered a complex situation which affected all areas of life, and the country’s health system was no exception. Gradual transition of the infrastructure was almost impossible owing to the ineffectiveness of the committee appointed by the United Nations. The situation was further complicated by the outbreak of the Arab–Israeli War. We relate for the first time the story of 75 Jewish patients who were left in a former British mental hospital in Bethlehem – deep behind the front lines. Despite the hostilities, there were complex negotiations about relocating those patients. This episode sheds light on the Jewish and Arab relationship as it pertained to mental institutions during and immediately after the British Mandate.

ABSTARCTBackground: Mental disorders and alcohol misuse are often comorbid, and this comorbidity is more common in those who develop mental disorders following exposure to traumatic events.Aims: To investigate the relationship between combat exposure and operational role (support versus combat) with mental disorders and associated comorbidity in a UK military cohort.Methods: 4896 participants from a UK military cohort reported their operational role and frequency of exposure to combat events during deployment. Outcome measures included self-reported post-traumatic stress disorder, common mental disorder and alcohol misuse.Results: Personnel reporting higher levels of combat exposure were more likely to meet criteria for two or more co-occurring mental disorders (odds ratio [OR] 3.90, 95% confidence interval [CI] 2.73-5.58). While having a combat role increased the risk of developing co-occurring disorders compared to having a support role (OR 1.67, 95% CI 1.26-2.23), this effect diminished following adjustment for variables including combat exposure (OR 0.89, 95% CI 0.62-1.27).Conclusions: Combat exposure may play a greater role in the development of comorbid mental disorders than operational role, i.e. job title. Clinicians treating military personnel should be alert to the increased risk of comorbid mental disorders and alcohol misuse among those with a history of combat exposure.

Radicalisation is the term proposed to explain how an apparently ordinary person can be transformed from a law-abiding citizen into a supporter of violent protest. It refers to a process of belief modification and requires a progression from feeling sympathy towards violence for a political goal to direct involvement in such activities. This paper explores the reasons why individuals are drawn to extreme movements and how approaches devised for public health can be applied to prevention. We argue for interventions at an early stage when ideas are beginning to take root in people vulnerable to the recruiter’s message and identify both protective and risk factors.

The association of post-traumatic stress disorder (PTSD) symptom clusters with combat and other operational experiences among United Kingdom Armed Forces (UK AF) personnel who deployed to Afghanistan in 2009 were examined. Previous studies suggest that the risk of developing PTSD rises as combat exposure levels increase. To date, no UK research has investigated how specific classes of combat and operational experiences relate to PTSD symptom clusters. The current study was a secondary analysis of data derived from a two-arm cluster, randomized-controlled trial of a postdeployment operational stress-reduction intervention in deployed UK AF personnel. 2510 UK AF personnel provided combat exposure data and completed the PTSD checklist (civilian version) immediately post-deployment while 1635 of the original cohort completed further followed-up measures four to six months later. A 14-item combat experience scale was explored using principle component analysis, which yielded three main categories of experience: (1) violent combat, (2) proximity to wounding or death and (3) encountering explosive devices. The association of combat experience classes to PTSD 5-factor "dysphoric arousal" model (re-experiencing, avoidance, numbing, dysphoric-arousal and anxious-arousal symptoms) was assessed. Greater exposure to violent combat was predictive of re-experiencing and numbing symptoms, while proximity to wounding or death experiences were predictive of re-experiencing and anxious-arousal symptoms. Explosive device exposure was predictive of anxious-arousal symptoms. The present study suggests that categories of combat experience differentially impact on PTSD symptom clusters and may have relevance for clinicians treating military personnel following deployment.

SummaryMoral injury, characterised by guilt, shame and self-condemnation, is conceptualised either as an adjunct to post-traumatic stress disorder or as a new syndrome. Studies of symptoms and potentially morally injurious events have produced a possible definition and informed the design of rating scales. The current challenge remains the design of effective interventions. Because moral injury relates to ethical behaviour, the meaning attached to events and perceptions of the self, moral philosophy and spirituality could contribute to the design of treatments.

BackgroundRadicalisation is proposed to explain why some individuals begin to support and take part in violent extremism. However, there is little empirical population research to inform prevention, and insufficient attention to the role of psychiatric vulnerabilities.AimsTo test the impact of depressive symptoms, adverse life events and political engagement on sympathies for violent protest and terrorism (SVPT).MethodA cross-sectional survey of a representative sample of Pakistani and Bangladeshi men and women from two English cities. Weighted, multivariable, logistic regression yielded population estimates of association (odds ratio (OR) and 95% confidence intervals) against a binary outcome of SVPT derived from a three-group solution following cluster analysis.ResultsDepressive symptoms were associated with a higher risk of SVPT (OR = 2.59, 95% CI 1.59–4.23,PConclusionsIndependent of SVPT associations with depressive symptoms, some expressions of social connectedness (measured as life events and political engagement) are associated with a lower risk of SVPT.

The challenge of transition from service to civilian life is explored through the experiences of a sample of 225 UK army veterans between 1945 and 2000. All subjects had a war pension for a psychological disorder, and most had served overseas in combat roles. Statements about issues of adjustment and health were analyzed by the constant comparison method. Although 20 themes were identified, three ('anxiety, nerves and depression', 'enduring illness attributed to combat exposure', and 'illness interferes with the ability to find or keep employment') accounted for 46% of the total and were reported by between 53% and 86% of subjects. Consistency was observed in the ranking of themes over time. In content, they replicate those reported by veterans of recent conflicts, suggesting that the core issues of transition have an enduring quality. Most statements (66%) date from the 1940s, a time when the application process for a pension required the veteran to provide an explanation for his illness. A rise in the number of statements during the 1980s and 1990s reflected wider cultural acceptance of post-traumatic illness and veteran population entering retirement with time to reflect on defining experiences.

The embellishment of a warrior biography has a long history but examples of veteran elaboration of traumatic experience have become increasingly apparent. Although legislative change in the UK has removed the penalties for fabrication and a progressive decline in the military footprint may have increased the likelihood of such false trauma narratives, a paradigm shift in explanations for mental illness underpins this phenomenon. The recognition of post-traumatic stress disorder (PTSD) in 1980, followed by studies to identify risk factors, led to a greater appreciation of psychological vulnerability. As a result, the use of shame to discourage acts formerly labelled as “cowardly” or “lacking in morale fibre” is no longer considered appropriate. Recent conflicts in Iraq and Afghanistan generated popular sympathy for service personnel, whilst media focus on PTSD has led the UK public to believe that most veterans have been traumatised by their tours of duty.

BackgroundUK veterans suffering from a psychological or psychiatric illness as a consequence of service in the Second World War were entitled to a war pension. Their case files, which include regular medical assessments, are a valuable resource to investigate the nature, distribution and duration of symptoms.MethodsA standardised form was used to collect data from pension records of a random sample of 500 UK army veterans from the first presentation in the 1940s until 1980. Data were also gathered from 50 civilians and 54 emergency responders with a pension for post-traumatic illness following air-raids.ResultsThe 10 most common symptoms reported by veterans were anxiety, depression, sleep problems, headache, irritability/anger, tremor/shaking, difficulty completing tasks, poor concentration, repeated fears and avoidance of social contact. Nine of the 10 were widely distributed across the veteran population when symptoms were ranked by the number of subjects who reported them. Nine symptoms persisted significantly longer in the veteran sample than in emergency responders. These included seven of the most common symptoms, together with two others: muscle pain and restlessness. The persistence of these symptoms in the veteran group suggests a post-traumatic illness linked to lengthy overseas service in combat units.ConclusionsThe nature and duration of symptoms exhibited by veterans may be associated with their experience of heightened risks. Exposure to severe or prolonged trauma seems to be associated with chronic multi-symptom illness, symptoms of post-traumatic stress and somatic expressions of pain that may delay or complicate the recovery process.

The scale of casualties in World War I and the reinterpretation of the conflict in terms of futility and waste suggest that many veterans experienced moral injury. Memory of the war was in part det...

The concepts of allostatic load, a pathologic response of allostasis, which is an adaptive process that restores homeostasis after acute stress, and overload, a dramatic increase in the allostatic load that predisposes to disease, have been extensively described in the literature. Herein we present data to support the hypothesis that some allostatic states (chronic regulatory system digressions away from its regular functioning level) may represent adaptive, rather than pathologic, mechanisms to deal with chronic anxiety and stress. In a rat model, we demonstrate that chronic stress induces adaptive changes in the lymbic-hypothalamic-pituitary-adrenal axis, and in lactate and glutamate/glutamine metabolism. Compared to rats with passive defensive response to stress, rats with active (offensive) responses had lower anxiety and plasma glucocorticoid levels, and increased lactate and decreased glutamate in the amygdala. These data suggest that allostatic states may represent adaptive endogenous autonomic nervous system strategies to calm the animal and restore homeostasis following chronic fear and stress. Funding: This study was supported by the Russian Science Foundation (grant #17-15013418), and institutional funds from the State University of New York (SUNY) Upstate Medical University. This is a TransCampus project. This work was implemented using the equipment of the Center for Genetic Resources of Laboratory Animals at ICG SB RAS, supported by the Ministry of Education and Science of Russia (Unique identifier of the project RFMEFI62117X0015). Declaration of Interest: All authors declare that there are no financial interests and no conflicts of interest. Ethical Approval: The study protocol was approved by the Committee for Bioethics and Humane Treatment of Laboratory Animals at South Ural State University, Russia.

In the last decade, instability has become a characteristic of international politics, whilst conventional armed forces are increasingly engaged in asymmetric warfare in novel or testing environmen...

The declaration of a caliphate by Islamic State in June 2014 witnessed the recruitment of increasing numbers of foreign terrorist fighters drawn from a diverse range of nations across the globe. This paper seeks to explore the appeal of extreme groups and how recruiters persuade young people to risk either their lives or lengthy terms of imprisonment. The processes of radicalization and recruitment are differentiated and compared with conventional means of encouraging individuals to enlist in state-sanctioned armed forces. The reasons why people join terrorist organizations are influenced by their education, formative experiences, and social or familial connections, whilst these variables, in turn, have an impact on the roles that they then undertake. Whether personality traits explain an over-representation of engineers and doctors amongst leaders of particular extremist groups remains a moot question. The increasing use of the internet and social media as instruments to propagate extremist philosophies may, in part, be responsible for the recent rise in sole actors. The need to involve respected and influential Muslim leaders and organizations is crucial in providing a counter-balance to the message of righteous adventure and belonging promoted by Islamic State.

In his response to our article,1 Remington Nevin argues that mefloquine exposure is an important confounder and that our failure to control for this variable invalidates our combat exposure model o...

Although recognized as a medical scientist, the work of Frederick Mott as a physician, educator and clinical policymaker has been overshadowed. As a late entrant to the asylum system, Mott questioned established practices of treating mentally-ill patients and campaigned for reform. During World War I, entrusted with the management of the Maudsley neurological section, he sought to raise clinical standards and experimented with a range of therapies designed to treat the most severe or intractable forms of shell shock. While Mott believed that psychiatric disorder was underwritten by inherited characteristics, he did not dismiss the impact of the environment. The diversity of his interests has led to an understatement of his contribution as a physician, not only to the design and founding of the Maudsley Hospital but also to the therapeutic regime practised there during the interwar period.

Summary The 100th anniversary of the outbreak of World War 1 could be viewed as a tempting opportunity to acknowledge the origins of military psychiatry and the start of a journey from psychological ignorance to enlightenment. However, the psychiatric legacy of the war is ambiguous. During World War 1, a new disorder (shellshock) and a new treatment (forward psychiatry) were introduced, but the former should not be thought of as the first recognition of what is now called post-traumatic stress disorder and the latter did not offer the solution to the management of psychiatric casualties, as was subsequently claimed. For this Series paper, we researched contemporary publications, classified military reports, and casualty returns to reassess the conventional narrative about the effect of shellshock on psychiatric practice. We conclude that the expression of distress by soldiers was culturally mediated and that patients with postcombat syndromes presented with symptom clusters and causal interpretations that engaged the attention of doctors but also resonated with popular health concerns. Likewise, claims for the efficacy of forward psychiatry were inflated. The vigorous debates that arose in response to controversy about the nature of psychiatric disorders and the discussions about how these disorders should be managed remain relevant to the trauma experienced by military personnel who have served in Iraq and Afghanistan. The psychiatric history of World War 1 should be thought of as an opportunity for commemoration and in terms of its contemporary relevance—not as an opportunity for self-congratulation.

Chemical weapons accounted for only 1 per cent of the 750,000 British troops killed in the First World War and yet caused disproportionate casualties (estimated at 180,100). The considerable investment in the development of new toxins and methods of delivery was designed to maintain the elements of surprise and uncertainty as these accentuated their psychological effect. Soldiers were continually challenged on the battlefield by combinations of different types of agent designed to undermine their confidence in respirators, disorientate them, and erode their morale. At first, army doctors practised defensive medicine, invaliding their patients for protracted periods to the UK or base hospitals. By 1917, progressive study of the physical and psychological effects of different types of toxin allowed physicians to design new management strategies. Borrowing ideas from shell shock, specialist units were set up closer to the front line and medical officers taught to identify crucial points in the course of illness to accelerate recovery times and forestall the accretion of psychosomatic symptoms.

To compare attitudes to mental illness in the U.K. military and in the general population in England.Using data from a cross-sectional survey of 821 U.K. military personnel and a separate cross-sectional survey of 1,729 members of the general population in England, levels of agreement with five statements about mental illness were compared in the military and the general population.The majority of respondents from both populations showed positive attitudes toward mental illness. The general population showed slightly more positive attitudes toward integrating people with mental illness into the community (68.0% [65.7%-70.1%] agreed that "People with mental illness have the same rights to a job as everyone else," vs. 56.7% [51.5%-61.7%] of the military). However, the general population showed more negative attitudes about the causes of mental illness (62.4% [60.1%-64.6%] disagreed that "One of the main causes of mental illness is a lack of self-discipline and willpower," vs. 81.3% [77.0%-84.9%] of the military).Overall, attitudes toward mental illness are comparable in the general population in England and the U.K. military. Differences included the military holding more positive attitudes about the causes of mental illness, but more negatives attitudes about job rights of those with mental illness. Strategies aiming to improve attitudes toward mental illness could focus particularly on personnel's concerns around mental illness impacting on their career.

After the 7/7 bombings radicalisation became a homegrown issue in the UK with Muslims born and brought up here being responsible for the attacks. This has had a subsequent impact on wellbeing and social cohesion in the UK. It feels the Government’s strategy of tackling radicalisation is ineffective and maybe paradoxically serving to increase recruitment to radical groups. There is limited primary research from a sociological or a psychological perspective on the issue of radicalisation amongst the Muslim community in the UK. Two focus groups with six men and ten women, aged between 22 and 56, were established to determine the meaning of radicalisation to Muslims, gather experiences of the impact of the concept of radicalisation on the wellbeing of the Muslim community, understand more about the sociological and psychological processes that lead to radicalisation and gather in-group perspectives on how to tackle radicalisation as a means to promote social cohesion. Islamophobic media coverage and discrimination affected the wellbeing of the Muslim community resulting in a more orthodox religious identity. Drivers of radicalisation were perceived to include inequalities, and misrepresentation of Islamic teachings. Solutions to tackle radicalisation and promote social cohesion included authentic Islamic education, greater integration and reducing inequalities with greater acceptance by the Muslim community alongside more responsible journalism. Although further work is needed in Muslim communities, there also needs to be work done on non-Muslim communities to further understand the impact of extremism on social cohesion and wellbeing.

There is significant variation in the way individuals react and respond to extreme stress and adversity. While some individuals develop psychiatric conditions such as Post-Traumatic Stress Disorder (PTSD) or Major Depressive Disorder (MDD), others, recover from stressful experiences without displaying significant symptoms of psychological ill-health, demonstrating stress-resilience. To understand why some individuals exhibit characteristics of a resilient profile, the interplay between neurochemical, genetic and epigenetic processes over time needs to be explained. In this review, we examine the hormones, neuropeptides, neurotransmitters and neural circuits associated with resilience and vulnerability to stress-related disorders. We debate how this increasing body of knowledge could also be useful in the creation of a stress-resilient profile. Additionally, identification of the underlying neurobiological components related to resilience may offer a contribution to improved approaches toward the prevention and treatment of stress-related disorders.

In 1943, Basil Wright produced a documentary film about the treatment of servicemen and civilians with psychological disorders at Mill Hill Emergency Medical Service Hospital. Funded by the Ministry of Information, Neuro Psychiatry was shot to convince influential clinicians and policy makers in North America that the British had developed expertise in the management of psychiatric casualties. By emphasizing novel and apparently effective interventions and excluding severe or intractable cases from the film, Wright encouraged an optimistic sense of achievement. Filmed at a time when victory was considered an eventual outcome, the picture presented a health service to which all had access without charge. Children and unemployed women, two groups excluded under the 1911 National Insurance Act, had been required to pay for healthcare in the prewar period and were shown receiving free treatment from the Emergency Medical Service. However, the therapeutic optimism presented in the film proved premature. Most U.K. battle casualties arose in the latter half of the conflict and follow-up studies failed to confirm the positive outcome statistics reported in the film. Aubrey Lewis, clinical director of the hospital, criticized research projects conducted at Mill Hill for a lack of rigor. The cinematographic skills of Wright and director Michael Hankinson, together with their reformist agenda, created a clinical presentation that emphasized achievements without acknowledging the limitations not only of the therapies offered by doctors but also the resources available to a nation at war.

For many hundred of years, military forces have included chaplains of various faiths. Although these personnel mainly concentrate on providing for the religious and spiritual needs of the armed forces, they also contribute to the mental health of service personnel. This article provides a historical overview of military chaplains, examines their contributions to the psychological health of allied forces in World War I and World War II, and offers an overview of the scope of their present and future mental health related activities. The importance of the relationship between medical officers and chaplains in diagnosing and treating mental health problems is also discussed. We conclude that chaplains are capable of contributing significantly to the mental health of armed forces personnel if they are able to do so in informal and collaborative way.

Changes in the clinical presentation of functional disorders and the influence of social and cultural factors can be investigated through the historical case notes from mental hospitals. World War I (WWI) was a potent trigger of functional disorders with neurological or psychiatric symptoms. We analysed 100 randomly selected case files of German servicemen admitted to the Department of Psychiatry of the Charité Medical School of Berlin University during WWI and classified them according to contemporaneous and retrospective modern diagnoses. We compared the clinical presentations with accounts in the German and British medical literature of the time. Most patients obtained the contemporaneous diagnosis of ‘psychopathic constitution’ or hysteria reflecting the general view of German psychiatrists that not the war but an individual predisposition was the basis for the development of symptoms. The clinical picture was dominated by pseudoneurological motor or sensory symptoms as well as pseudoseizures. Some soldiers relived combat experiences in dream-like dissociative states that partly resemble modern-day post-traumatic stress disorder. Most servicemen were classified as unfit for military service but very few of them were granted compensation. Severe functional disorders of a neurological character could develop even without traumatic exposure in combat, which is of interest for the current debate on triggers of stress disorders. The high incidence of pseudoseizures accords with the psychiatric literature of the time and contrasts with accounts of war-related disorders in Britain. The tendency of German psychiatrists not to send traumatised servicemen back to active duty also distinguished between German and British practice. Our data contribute to the debate on the changing patterns of human responses to traumatic experience and their historical and social context.

The mental health of the UK Armed Forces is a topic much debated by healthcare professionals, politicians and the media. While the current operations in Afghanistan, and the recent conflict in Iraq, are relevant to this debate, much of what is known about the effects of war upon the psyche still derives from the two World Wars. This paper will examine the historical and contemporary evidence about why it is that some Service personnel suffer psychological injuries during their military service and others do not. The paper will also consider some of the strategies that today's Armed Forces have put in place to mitigate the effects of sending military personnel into danger.