Nigel C. Hunt Memory, War and Trauma PDF

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Memory, War and Trauma
Many millions of people are affected by the trauma of war. Psychologists

have a good understanding of how experiences of war impact on
memory, but the significance of external environmental influences is
often disregarded. Memory, War and Trauma focuses on our under-
standing of the psychosocial impact of war in its broadest sense.
Nigel C. Hunt argues that, in order to understand war trauma, it is
critical to develop an understanding not only of the individual perspec-
tive but also of how societal and cultural factors impact on the outcome
of an individuals experience. This is a compelling book which helps to
demonstrate why some people suffer from post-traumatic stress while
other people dont, and how narrative understanding is important to the
healing process. Its multidisciplinary perspective will enable a deeper
understanding of both individual traumatic stress and the structures
of memory.
n i g e l c . h u n t is Associate Professor in the Institute of Work,

Health and Organisations at the University of Nottingham.
Memory, War and Trauma
Nigel C. Hunt
CAMBRIDGE UNIVERSITY PRESS
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Cambridge University Press

The Edinburgh Building, Cambridge CB2 8RU, UK
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Nigel C. Hunt
This publication is in copyright. Subject to statutory exception and to the

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First published in print format 2010
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accurate or appropriate.
For Sue
Contents
Preface page ix
1 Background and purpose 1

2 Historical perspective 14
3 Methods and ethics 28
4 Current theory: post-traumatic stress disorder 50
5 Approaches to understanding trauma 61
6 Positive outcomes of traumatic experiences 81
7 Memory and history 96
8 Personal narrative and social discourse 114
9 Illustrating narrative as a scientific technique:
the role of social support 127
10 Ageing, trauma and memory 140
11 Literature and trauma 161
12 Memorialisation and commemoration 172
13 Battlefield tours 186
14 Conclusions and future directions 196
References 206
Index 222
vii
Preface
I first became interested in the different ways people interpret war and
the memory of war when I was a child, when I saw how my parents
looked back on the Second World War with very different views. My
father, who, in the RAF, was a participant throughout, tended to be
neutral, not indifferent, but saw those 6 years with a mixture of positive,
negative and inevitably fading memories; my mother, who was a child
and adolescent, looked back with anger, seeing the war as a period which
disrupted and destroyed her childhood; so I knew from an early age that
people thought about the same events very differently.
This book is a culmination of my thinking over the last few years: from
a recognition that much of what I was taught about memory as an
undergraduate student was simplistic, focusing largely on a narrow
individualistic view of memory as some kind of inputstorageoutput
device which lacked explanatory value in terms of the way memory really
works; to a growing recognition that in order to understand people and
their thought processes psychologists such as myself should draw on the
knowledge and understanding from other disciplines, such as history
and sociology, in order to develop a fuller understanding of the ways
in which people think. Furthermore, psychologists can learn as much,
or more, from reading a good novel as from reading the scientific
literature. A narrow disciplinary focus does not lead to good science,
just restricted understanding. In the same way, modularisation has had
many negative effects in higher education by artificially separating our
subjects into discrete areas that are perceived as having little overlap; the
modularisation of disciplines restricts the development of knowledge
and understanding about whatever aspect of the world one is interested in.
The title of the book gives away the foci. If we are to understand
memory we must explore the influence of culture and society, and how
memories are affected by the stories we tell ourselves and others the
narratives. At this level there is also a complex association between
memory and history, and the ways in which memory becomes history
over generations. War and trauma are unfortunately closely interlinked.
ix
x Preface
Many people who experience war are traumatised by its effects (though
many more are not). Most previous research into war trauma has
focused on the individual effects. In this book I attempt to integrate
material across disciplines (e.g. history) and across methods (not only
standard quantitative and qualitative methods, but also literature and a
battlefield tour) to develop a more rounded understanding of what war
does to people.
I would like to thank the people who, in one way or another, have
contributed to the making of this book. In the first place the veterans of
war. I have talked to many of these over the years veterans of wars
going back to the Second World War and sometimes back even further to
the First World War and coming forward to the wars that are still being
fought. In one sense all these people share common experiences, from
the boredom, excitement, fun and comradeship on one side, to the
terror, horror and grief on the other. In another sense they differ greatly.
People who fight in wars in different times and places are not treated the
same, and the psychological outcomes are not the same. Prior to the
twentieth century, few people took any interest in what happened to
soldiers. Those who fought in the British armed forces in the Second
World War were treated as heroes; those who fought in the German
armed forces at the same time were forgotten, as were the experiences of
many British troops during the final colonial period in the 1950s, 1960s
and 1970s. In the USA, troops returning from Vietnam were often seen
as murderers. In terms of treatment for war trauma, that has changed
dramatically throughout the twentieth century, as indicated by the front
cover of this book, which represents the men who were shot at dawn by
the British authorities in the First World War. In modern times many
would have been treated for post-traumatic stress disorder.
I would also like to thank those people who have personally helped me
through the long process of writing this book. Many of them were
probably unaware that they were doing so, because the writing of a book
is a lonely business, and getting on with real life with family and friends is
very important to me, even if it does delay the completion of the book.
I would like to thank my parents for inspiring me in the first place, and
for being there when I have needed them; the rest of my family and the
children (both now adults) Jack and Conor; my friends, including every-
one in the Yew Tree, South Wingfield, and the footballers at Lea
Green on a Monday night. I would also like to thank those who have
helped me along with my thoughts over the years, particularly Ian
Robbins and Peter Coleman. My employer, the University of Nottingham,
by enabling me to take slightly longer than usual holidays in the summer
has inadvertently granted me short sabbaticals during which I write.
Preface xi
I am also grateful to the University of Helsinki, particularly Airi

Hautamaki, for allowing me several weeks of space during which
I wrote a significant part of the book.
Most of all I would like to thank my wife, Sue, for putting up with me
while writing this book, for commenting on earlier drafts of certain
chapters that were unclear to me until she told me how to put the
material in the right order, for being dragged to famous and obscure
battlefields from the Russian Front and Leningrad to the Ebro, Bull Run
to Sarajevo (though, with her love of France, such places as Normandy,
the Vercors, Verdun and the Somme were easier destinations), and for
putting up with me writing the book when we were on holiday in Spain.
I would like to dedicate the book to her.
1 Background and purpose
I was recently asked to write about the health consequences of war

(Hunt, 2008). I started by trying to trace the number of casualties in
the wars of the twentieth century, but quickly gave up trying to obtain
any sort of accurate account; records were often not kept, or were lost
during wars, were deliberately manipulated by the winners or by the
losers, or the records are still (presumably) in secret files. I then tried
counting the number of wars during the century; this too became very
difficult, as so many of them are relatively minor in terms of casualties
(unless you are a participant). In the end I gave up trying to look at every
war. I ended up focusing on those wars where there were more than
1 million dead. Accounting for the wounded and sick, and those with
psychological problems, these are wars with possibly 5 million casualties
and then there is the impact on surviving family members and
friends. The twentieth century had around 26 such wars if we count
episodes such as Stalins campaign against the Kulaks and Chairman
Maos killing of the Chinese, which were not strictly wars, but were internal
actions that still led to millions of deaths. On the basis of the figures
available, I calculated that, overall, around 240 million people (give or
take 50 million) had died as a result of these large wars in the twentieth
century not counting the victims of smaller wars. Adding the injured,
that makes possibly 1 billion casualties. And that does not include all
those psychologically damaged people, many of them civilians, who have
had to live with their memories for the rest of their lives memories of
torture, massacres, death of family members, starvation, exile and rape.
There are also the thousands or millions of perpetrators who carried out
these acts, but whose voices are rarely heard. They are still people who
have had to live with their memories of what they did. They are still, in
some ways, victims.
These numbers are too large to comprehend. They are also probably
widely inaccurate, but they do serve to show the scale of modern
warfare, and how it impacts on so many people across the world, either
directly or indirectly. This book is about the psychological casualties of
1
war. Casualties are not just those who are killed or wounded, or civilians
who are caught up in the fighting or just happened to get in the way of
marching troops; they are ordinary people who cannot bear their
memories of what has happened the traumatised. We cannot accurately
estimate the number of victims of war who are psychologically damaged
by their experiences.
This book is an account of the psychosocial impact of war in its
broadest sense that of understanding memory not just as individual
memory, but also as the ways in which other people, society and culture,
and history, all affect how we remember. It considers the relationship
between memory, war and traumatic stress. Many people have psycho-
logical problems as a direct consequence of war; many have terrible
memories of these experiences that they find difficult to deal with; and
many never do learn to deal with these memories. How can you come to
terms with killing people, the loss of a child, or being raped multiple
times, or remembering that you have killed civilians, or that you have
had to permanently leave your home and your family?
On the other hand, we also know that the majority of people who go
through these experiences do not have serious long-term problems, and
that they are able to handle their memories and emotions and get on
with their lives, more or less successfully. Many may still experience
intense emotion when they think of what they have been through, but
that does not mean they are traumatised. There is ample evidence to
show that many of the psychosocial responses that we observe within a
culture are not universal, that in some historical periods more people are
likely to have problems, and in different cultures and historical periods
they have different kinds of problems. Why is this so? What is it about
memory, war and traumatic stress that make it so difficult to fully
comprehend? Psychologists have studied memory for well over a cen-
tury. We have studied the impact of war for just about as long. We have
developed good theories and effective ways of treating people trauma-
tised by war, yet still our understanding has serious limitations. It is
argued here that some of these limitations are due to focusing too much
on the individual, and not enough on the social and cultural world in
which we live.
While there is a lot of good research fascinating, detailed and useful
theories about traumatic stress, and, perhaps most importantly, thera-
pies that help people to cope with the overwhelming response our
understanding of memory and trauma still has something missing.
Memory is not objective; it is not some kind of computer-like registra-
tion, storage and retrieval system. Memory is flexible, permeable,
changeable, and critically affected by the social and cultural world
Background and purpose 3
in which people live. We live in the world as social beings; we do not and
cannot live in isolation. No matter what the Zeitgeist says that we live
in an increasingly individualistic society in the end we depend on
culture and we depend on each other. These are essential to psycho-
logical health. This is why social support consistently comes out as being
the most important factor concerning how people deal with stress and
difficulties in their lives.
The other key concept that is used throughout the book is that of
narrative. We constantly narrate our lives, creating and telling stories
about who and what we are, and why we exist. We are natural storytellers
and natural audiences (you can see the link to social support). Narrative
is an essential function. We use and manipulate our memories, con-
sciously and unconsciously, in order to present ourselves to the world
in a particular way. Our life stories are constantly changing according to
our circumstances. We do not have any choice in the matter. We are
compelled to narrate.
Low perceived social support is seen as a predictor of traumatic stress.
If a person experiences a traumatic event and they do not perceive that
they have good social support, then they are more likely to be trauma-
tised than if they perceive that they have good social support. Our
fundamental need for narrative is met by interacting with others, by
being able to narrate their problems, work them through, with someone
who will listen appropriately. Social support is used to help people
resolve their issues through discussion.
While narration is about storytelling and the construction of narratives
that may relate closely to how events actually happened, or they may
be largely fabricated, the argument is not that we fabricate our lives,
but that psychological reality is more fluid, social and malleable than
we usually think. In the context of the response to war then, this must
be taken into account when we are building our theories, when we are
trying to treat people with war-related psychological problems, and
when we are just listening to war stories.
We must include the social and narrated worlds in our psychological
theories. In order to do this effectively, psychological research is not
enough. If we are to understand the nature of war, and the impact it has
on people, then we must examine other approaches to understanding,
through, for example, literature, history and the media. This book
weaves together the story of memory, war and trauma by drawing on
these different elements to increase our understanding of the lived
experience and impact of war. Any psychologist who tells you that they
can only learn about human nature from reading a psychology journal
article or textbook, without considering the contribution of a good
novel, play or poem, is nave. We are studying behaviour, in all its shapes
and forms, and good literature is part of that tapestry of understanding,
along with historical accounts, sociology and politics.
Narrative, social discourse and collective memory

These concepts are central to the arguments presented in this book.
Individual narratives are what we all have as explanations of our selves,
our immediate environment and the world. Our narratives provide us with
memories and with the sets of beliefs by which we conduct our lives. They
are more or less coherent, more or less individual, and more or less mean-
ingful, depending on the characteristics of the person and their situation.
These narratives must have origins, and there are a number of sources
for them. Narratives, life stories or autobiographies1 depend on social
discourse the main themes and threads of argument that are the social
world. This is everything from common notions of the representation of
the sexes, race or homosexuality, through to the use of particular terms that
have ambiguous and changing meanings, such as cripple, lady or queer.
The importance of social discourse the way people interpret events
should not be underestimated. The example below is contentious, and is
intended as such, because it illustrates how our personal narratives, our
ways of thinking, are affected by social discourse. Holocaust is a term
that most people agree pertains only or mainly to the killing of Jews in
the Nazi era. Indeed, denial of this is a crime in some countries, as David
Irving found to his cost in Austria when he was imprisoned for this
offence. The recognised social discourse is that the Holocaust was the
most terrible, evil series of events known to mankind. This is the social
discourse that not surprisingly began to be created immediately after
the war by the surviving Jews. They wanted people to remember. They
knew it was important to tell people about what had happened, to
inform future generations, to try and keep it as a living memory, in order
that it would not happen again. The stories of the extermination camps,
the brutality and the cold-blooded murder are unquestionably horrific.
Few would argue that what happened to the Jews in the Second World
War was utterly abhorrent, a crime against humanity, and something
that is very difficult to comprehend by those who were not there. But
there is an alternative social discourse that there have been many
1
Interestingly, mainstream psychologists only started to talk about autobiographical
memory about 20 years ago. It was then thought of as a novel concept, rather than
something that people in all societies have understood the need for and purpose of for
millennia. It was the same with the concept of consciousness around the same time.
Narrative, social discourse and collective memory 5
periods in history that have been just as bad as the Holocaust for
example, the Stalinist era of the USSR, the Maoist massacres in China,
Pol Pots regime in Cambodia or the ethnic cleansing in Bosnia. This is
not about scale (though some were on a greater scale than the Holocaust);
it is about the depth of human tragedy.
Another example where the term holocaust may apply is the destruc-
tion of the native people of North America. Many of the terms
that generally applied to Nazi Germany are at least as applicable in the
nineteenth-century USA context. For instance, Lebensraum represents
the idea that the white man wanted the whole of North America for
himself, and that there was no room for the untermensch (the native
people). This was genocide (the natives of North America were destroyed
in the same way Hitler intended for the Jews) and, to use a more modern
term, ethnic cleansing. The term holocaust may be even more appro-
priate to nineteenth-century USA than to twentieth-century Germany
because the state the USA deliberately set out to cleanse a continent of
its indigenous people and replace them with Europeans. They succeeded
almost completely, while Hitler tried to remove one tribe from Europe,
and only partially succeeded. We now see that tribe thriving in Palestine
(the Holy Land, Israel take your pick of social constructs), while the
few survivors of the North American tribes live mainly in reservations,
perhaps better described as concentration camps.
It is not that the destruction of native North Americans was
conducted in the same way as the destruction of the Jews in Hitlers
Germany, nor that the intentions of the perpetrators were necessarily
the same; it is that the nature of the social discourse the ways in which
the events are interpreted plays a crucial part in peoples individual and
collective memories of those events.
If we are to understand our narratives of war or of anything else we
must understand the power of the social constructions we use when
describing our behaviours and our thoughts and feelings. The examples
above are not wrong; it is just that society at least Western society
accepts a particular social construct. If the allies, including the USA, had
lost the war against Germany in 1945, then the situation the social
construct would be very different. The history books, which contain
the social constructs of a society, would contain very different stories.
There is a relationship between individual narrative and social dis-
course, with one impacting on the other, but there are other key variables
that must be included in the equation: the first is collective memory.
Collective memory is information about society that is accumulated over
the years and develops into a kind of social fund, and is drawn upon
in the development of social discourses and individual narratives.
Collective memory is important for the notion of commemoration and

memorialisation so important to many societies, and individuals, when
remembering war.
A second key area is that of the relationship between memory and
history. There is an increasing need to define these terms clearly and
consider their interaction. The link between psychology and history is
central to this book. Traditionally, memory studies have focused on the
memory of the individual person, or sometimes on the notion of a
collective memory, but still focused on actual memories. History has
been the systematic and relatively objective study of the past, whether
that is concerned with individuals, societies or politics. There is now
a blurring of the edges as is to be expected from the increasing
interdisciplinarity we are finding throughout academia and the distinc-
tion between memory and history has become blurred. For example, the
growing field of oral history loved and hated by both psychologists
(hated for not being the scientific study of memory, loved because it
focuses on real remembered memories) and by historians (hated for not
being sufficiently objective and relying on unreliable eye-witness
accounts, loved because it is personal and social) exemplifies the
strength of an interdisciplinary approach, drawing on the resources of
the historian and the detailed memories of individuals who lived through
the times of interest. Psychologists are increasingly interested in the study
of individual detailed memories outside the narrow confines of the labora-
tory, as it is only through this approach that they can begin to understand
the complexities of the mind. These are explored in later chapters.
Thus narrative is central to our understanding of self and identities.
These narratives depend on the social context, including the audience
they are designed for, as well as individual motivation and desires.
Memory itself is constructed partly through narrative and the social
context. If we wish to understand war trauma, we need to take into
account these narratives and the socio-cultural situation the person lives
in. At the same time, there are also fundamental underlying universals
regarding memory, the stress and fear response and other variables which
also determine the response to traumatic experiences such as war, and
through which psychologists have developed a good understanding via
laboratory and other research.
War trauma
An agreed definition of the central concept of war trauma is difficult to
obtain, as there is disagreement over the terms that should be used when
discussing the psychological effects of traumatic situations such as war.
War trauma 7
The distinction between stress and trauma is critical; while most authors
would agree there is a distinction, this is not always made clear. The
term stress was used by Cannon, an early pioneer in the area, to
describe a stimulus physical or emotional that disturbs a persons
internal homeostasis or balance, and that may be pathological if it
reaches a critical level (Cannon, 1929). Selye (1956) defined stress as
changes within a biological system that occur as a response to stressors,
environmental stimuli that evoke such internal changes. Mason (1975),
building on the work of Selye, argued that whether or not a stress
response occurs depends on a range of individual variables such as
appraisal, coping style and critically for our discussion the social
world. Levine and Ursin (1991) define stress as a situation where the
body anticipates or determines that there is some threat to the organism,
and organises the bodys defences against that threat in order to restore
homeostasis. The stress response is a normal and predictable response to
environmental threats. It only becomes a problem when the threat is
sufficiently prolonged or intense that it overwhelms the bodys resources.
Traumatic stress is fundamentally different to ordinary stress, in the
sense that there is a fundamental rift or breakdown of psychological
functioning (memory, behaviour, emotion) which occurs as a result of
an unbearably intense experience that is life threatening to the self or
others. It is usually a time-limited experience (even within the context of
war, traumatic experiences usually occur relatively rarely) of such inten-
sity that the resources of the person are overwhelmed. There are a set of
symptoms associated with these changes, including intrusive recollec-
tions, avoidance and emotional numbing, and hyperarousal. The over-
whelming nature of the event is such that it leads to important and often
permanent changes in the physiology and mental state of the individual.
A traumatic memory is formed, a memory that is at once cognitive,
emotional and possibly behavioural. The traumatic memory does not
exist in normal stress. The traumatic memory relates to the persons
initial unconscious response to the traumatic event. As the person sur-
vived the event, the memory is indelibly fixed within the mind. This
is adaptive. The person experienced a life-threatening situation and
survived, and so if the same traumatic situation arose in the future, they
should behave in the same manner again, hence increasing their chances
of survival. So in this way, the traumatic response can be an evolutionary
useful process. Unfortunately, owing to the mechanisms involved (which
will be explained later), that response contains memorised bodily and
psychological responses that are potentially damaging to the psyche.
This traumatic response can recur in different ways. For some people,
the memories of the event are overwhelming and continuous, and they
are traumatised. They find it difficult to cope with ordinary living,

because their memories are emotionally unbearable. In response to
this they may withdraw emotionally to help them cope, and so find
themselves withdrawing from their family and friends their key social
support. This can lead to a range of clinical problems. Other people
manage to suppress their memories, whether through conscious or
unconscious mechanisms. They are able to avoid thinking about them.
They may need to avoid reminders such as the place where the event
took place, or the people involved, but they successfully manage to get
on with their lives. When they do think about what happened, they
manage to deal with the memory. Another group of people actively think
about what happened their memories, their emotions, their bodily
responses and they work through or cognitively process their
responses, change their narratives of the time, and perhaps even learn
from what happened, maybe becoming a better person. The final group
of people, perhaps the majority, who live through a traumatic event are
not traumatised at all. They have no difficult emotional memories or
problems. They can probably look back at the event and perhaps they get
emotional, but it does not really bother them unduly or in a prolonged
manner.
The details of the traumatic response will be discussed later in the
book; suffice to say now that war trauma is concerned with the responses
of people to their war experiences. We are concerned not only with those
for whom the experiences are genuinely traumatic, but also those who
live through these events and are not traumatised. By understanding the
individual factors that determine whether or not someone is traumatised,
we can perhaps learn to help those who do have difficulties.
But what is a traumatic stressor? The clinical classification of a trauma
has changed throughout the years in which it has been represented in
the classification systems DSM and ICD. When post-traumatic stress
disorder (PTSD) was first introduced in 1980, as described in the
Diagnostic and Statistical Manual of Mental Disorders, 3rd edn (DSM-III,
American Psychiatric Association, 1980), there was an attempt to
objectify the stressor, to say that the event must in some way be extraor-
dinary, outside the range of normal human existence. The attempt was
to include things such as war, disaster or rape, but to exclude events such
as the death of a loved one. In later editions (DSM-IV, American
Psychiatric Association (APA), 1994), a more subjective interpretation
has been accepted; the interpretation of the individual was then con-
sidered to be more important. Rather than closely define the traumatic
event, there was a greater emphasis on the persons response (fear,
horror, helplessness) to the event. If there was an event and a response
Post-traumatic stress disorder 9
of fear, helplessness or horror, then it was considered satisfactory for

a person to have that diagnostic criterion.
This change came about because there was no acceptable answer to
the question regarding which kinds of events could be traumatic. The
argument is that an event is traumatic if it traumatises the person. What
is traumatic for one person may not be for another. The argument is
circular, which is why understanding both the psychological and bodily
response to the event is critical. The event, to be traumatic, must cause
changes in bodily coping mechanisms that effect possibly permanent
changes to the individual. These should, in principle, be measurable
both physiologically and psychologically.
Researchers have studied a range of phenomena that have been classi-
fied as traumatic. These include short-term, usually isolated events such
as rape or armed robbery, man-made disasters such as the sinking of
ferries, natural disasters such as earthquakes or floods, and often longer
term, chronic conditions such as war and child abuse. The negative
psychological effects of these disparate traumatic events are very similar,
though Herman (1992) and others have drawn a useful distinction
between simple and complex PTSD. Simple PTSD usually, but not
necessarily, relates to a single event. Complex PTSD refers to the
response to complex events such as war or chronic child abuse. We will,
of course, be mainly concerned with the more complex forms of the
disorder. Though the general symptoms are similar, there are compli-
cating factors, which will emerge in our discussion of war trauma.
Post-traumatic stress disorder

War trauma is not the same as PTSD, as the range of symptoms is much
broader in the former, but the construct is in many ways a useful one.
This will be discussed in more detail in Chapter 4, but it is helpful to
have an outline of the disorder here.
The Diagnostic and Statistical Manual of Mental Disorders, 3rd edn
(DSM-III) (American Psychiatric Association, APA, 1980) provided
the initial diagnostic criteria for PTSD. These criteria have since been
revised several times (DSM-III-R, APA, 1987; DSM-IV, APA, 1994;
DSM-IV-TR, APA, 2000). The key criteria, apart from the event itself,
now include intrusive re-experiencing, avoidance, emotional numbing
and hyperarousal. In order to be classified with PTSD there must also be
a significant impact on social, occupational or family functioning.
Finally, there is a temporal component, to include acute (over 30 days),
chronic (longer than 3 months) and delayed-onset (symptoms appear
after more than 6 months) PTSD.
The main symptoms are, in themselves, often normal responses when

the situation is normally stressful. Someone distressed by everyday
events, whether students sitting exams or someone going for a job
interview, will experience intrusion and avoidance. If a person has to
sit an exam, then they may spend hours worrying about it unduly. They
may also spend hours in avoidance perhaps visiting the pub or going for
a long walk in the country. These symptoms are normal. It is only when
someone is devastated by a terrible, overwhelming event that these
normal responses or coping strategies become abnormal, the mem-
ories become unbearable, emotions run riot, and it is impossible to live
ones life in a normal manner.
A traumatic event, by definition, breaks down the accepted social and
personal structures and belief systems of the individual. If you believe in
the essential goodness of other people, then your experience of trauma
will demonstrate that belief to be false. If you believe that terrible events
will not happen to you perhaps because it is statistically unlikely and
you are on a ferry that sinks, then in the future you may not want to go
near a ferry because you now believe that it is likely to sink. This can
make life very difficult for the traumatised person, and any treatment
must try and rebuild their belief system, not one that is identical to the
pre-trauma system, but one that includes the new knowledge provided
by the traumatic event. In the end, as argued in Chapter 6, this can lead
to someone knowing that they have psychologically benefited (or experi-
enced positive growth) because of their experiences and that they are in
some way wiser, more knowledgeable and more caring than they were
before.
Trauma and identity

War experiences can fundamentally change ones sense of self or identity.
Our identity consists of the beliefs we hold about ourselves, the world
and the future. A person may grow up thinking that on the whole people
are good, that the world is a safe place and that one is safe in the world.
War can change that. Witnessing and taking part in battle, being
involved in killing, being captured and perhaps subjected to torture,
taking part in being a victim of or witnessing atrocities against other
soldiers or against civilians, destroying artefacts all of these can lead to
a breakdown in ones belief systems and have an impact on ones iden-
tity. The traumatised soldiers positive beliefs about the world break
down, and with those beliefs can go everything which the soldier con-
siders important love of family and friends, concern about the future,
concern about protecting ones life. This is war trauma, though a host
Civilians 11
of other names have been applied to essentially the same condition:

shellshock, battle neurosis, war neurosis, battle fatigue and combat
fatigue, though many of these terms have been applied specifically to
soldiers rather than to all people traumatised by war. Whatever name
is applied, the results are the same. In combat, many soldiers experience
a total physical, psychological and emotional breakdown that can have a
long-term or permanent effect on their sense of identity. It is similar for
civilians traumatised by war, though in many ways it is worse, because
while the soldier has some limited control over his actions, the civilian
has no such control; and the traumatic response is linked to the degree of
control one has over a situation.
After the war: soldiers leaving the armed forces

Soldiers leaving the armed forces always have problems. They have to
learn to adapt to civilian life, and they leave the family they may have
known for many years. For some, this may be the only family they have,
one which has provided them with effective support, or comradeship.
Whatever the circumstances, the ex-soldier has to adapt to a new iden-
tity. For some, this is a difficult time, which may lead to them experi-
encing a form of war trauma, resulting not necessarily from particular
combat experiences, but from the novel experience of being a civilian
and being unable to adapt.
The effects may initially be subtle, only becoming serious over time:
they get bored, they get aggressive, they drink, and they have difficulty
holding down a job. When a soldiers identity is destroyed they cannot
cope in the world. There is often a whole series of psychological symp-
toms of anxiety and depression, what we recognise as PTSD, and
problems relating to drugs, violence or suicidal tendencies. Initially
there is a slow deterioration in their psychological health. At first it is
not really a problem; it is only over months or years that it becomes
clinically significant.
Civilians
The concern in this book is not just with traumatised soldiers, but also
with all those, including civilians, who are caught up in the trauma of
war. Throughout the twentieth century, an ever-increasing proportion
of the victims of war were civilians. The proportion of civilians affected
by war in the twentieth century rose from around 10% of casualties
in World War One, to 50% of casualties in World War Two, to 90% in
Bosnia. Of course, this is not a linear increase, and it is not that civilians
did not in the past suffer greatly because of war. In the English Civil War,
from 1642 to1648, it has been estimated that around 3% of the popula-
tion died, from soldiers in battle to civilians from famine and disease.
Civilians experience war differently to soldiers. With significant
exceptions, they do not have guns; they are not trained to kill. They
are often women, children or older people, and there are many psycho-
logical issues specific to these groups. Children who experience war
trauma have their beliefs shattered before those beliefs have even been
fully formed. That can affect the rest of their lives. The same goes for
women who are raped by soldiers. Civilians are generally powerless to
protect themselves. They have not been trained in, and prepared for,
the brutalities of war.
Finally
This opening chapter has looked at the background to the book, and has
begun to define what we mean by war trauma. We will return to this
theme in later chapters. After one further introductory chapter exploring
the historical background to our understanding of trauma (Chapter 3),
the book is split into three main sections.
The first section explores our current perspectives on trauma and
memory. We cannot function as scientists without clear methods, so
Chapter 3 focuses on methods and ethics. Trauma psychologists use
methods that are similar to other psychologists experiments, inter-
views, surveys and so on but they are adapted to the practice of applied
trauma research. That is, the methods may not always be applied in a
pure manner; compromises are made according to the sometimes diffi-
cult circumstances in which researchers find themselves. The ethical
issues in trauma research are potentially serious, as there is the potential
to cause distress to participants, for example by making them relive their
experiences, and harm to researchers, particularly if they collect data in a
war zone, but also just through interviewing traumatised people, some of
whom can be angry and violent. Chapter 4 focuses on PTSD, describing
the construct, and its validity and limitations with regard to war trauma.
For a full description of the symptoms associated with war trauma, we
need to look at comorbid disorders such as depression and substance
abuse. Chapter 5 focuses on our broader understanding of war
trauma, drawing on research from a number of fields to describe current
theory. It also looks at ideas about how we manage to cope with these
memories. Chapter 6 takes a different angle, looking at research on post-
traumatic growth, a relatively recent area within psychology which
focuses on how many people go through traumatic experiences and
Finally 13
emerge having experienced positive life changes, for example a better

understanding of the meaning of life or relationships.
The next section is concerned with the centrality of narrative to the
understanding of trauma, and is the heart of the book. Up to this point,
the main focus of the discussion has been the individual; it now moves
out to the socio-cultural perspective and the relationship between the
individual and the social world. Chapter 7 looks at the relationship
between memory and history a contentious relationship ignored by
psychologists though discussed extensively by sociologists. Chapter 8
builds on this and considers narrative and social discourse the key link
between the understanding of the personal narrative and memory, and
how they interact with the social world.
There is little point in building theory that does not relate to practice,
particularly in the area of traumatic stress, where the final aim is always
to help people improve their lives, though we also hope to advance
our theoretical understanding, so the last section focuses on practical
examples, beginning with Chapter 9, on how narrative can be used
scientifically to explore war trauma. Chapter 10, on ageing and trauma,
draws on my research and others to explore the specific areas relevant to
people who are ageing: how traumatic events can have a permanent
effect on life, and how old age can change the nature of the trauma.
In Chapter 11 there is an account of how psychologists can draw on
literature in order to understand traumatic stress. Many people who
have experienced war have written about it in detail, and as Shay
(1994) argued, some of this literature can extend our understanding
of traumatic stress by going further than, say, an account of PTSD.
Chapter 12 goes back to the relationship between the individual and
society, exploring the role of memorialisation and commemoration,
and how societal and cultural memories change and develop over time,
changing the ways in which individuals remember. Chapter 13 is a
slightly unusual chapter for a psychology book, extends the previous
chapter and describes battlefield tours and their importance, showing
how people who have not experienced battle wish to participate in
remembrance activities on the battlefield itself. There are examples of
such tours provided, along with some ideas about how to build such a
tour. This is an example of practical collaboration between individual
and societal memory. Finally, Chapter 14 draws the material together
and suggests how psychologists and others can benefit from this broader
interdisciplinary and practical perspective, not only to advance theory
and understanding about the psychology of war trauma, but also to
help in the treatment of those who have been affected by war.
2 Historical perspective
The effects of traumatic war experience have been recorded throughout

history (Trimble, 1985), particularly through literature. Evidence of
flashbacks, dissociation and startle response might be seen as witchcraft
(Rosen, 1960) or acts of God (Ellenberger, 1970). In the western world
the evidence can be traced back at least as far as the Bible, though it was
not until the nineteenth century that the scientific study of the psycho-
logical responses to war experience was considered in any detail.
Furthermore, the terminology used to describe trauma is very recent,
so we have to be cautious about interpreting what authors from the past
were saying. We should try to avoid over- or under-interpreting infor-
mation. People in previous eras did not only describe things differently
they were different. They were brought up to behave in particular ways,
they were used to death in a way that few people in the West are now
used to it, and they had different attitudes and beliefs. The past is
another world.
The Bible describes the siege of Jericho, where all the soldiers of Israel
marched around the city walls for six days, and where on the seventh day
trumpeters blew their rams horns as the army marched around the walls
seven times, then all the people shouted, and this led to the walls of the
city falling down. The story is not meant to be taken literally, but is an
illustration of how traumatic loud noises can be. One can imagine the
people inside the besieged city getting increasingly distressed as this went
on, and finally flinging open the gates when they could stand it no more.
This is a tactic used more recently, such as the rock music played at the
siege of Waco or by the US forces attacking General Noriega in Panama.
Nearly 3,000 years ago Homer1 described in the Iliad the experiences
of Achilles and his comrades in the last stages of the siege of Troy.
Achilles, after the death of Patroclus his friend, mentor and possible
homosexual partner experiences psychological symptoms that we
1
Assuming he existed as a single person, which appears unlikely.
14
Historical perspective 15
would now describe as PTSD: bad dreams, withdrawal, social isolation,

guilt, etc. This has been described very well by Jonathan Shay (1991),
who likened the experiences of Achilles to the symptoms of PTSD
experienced by Vietnam veterans. Around 400 years later, at the Battle
of Marathon, Herodotus described how an Athenian soldier collapsed in
the midst of battle. He was found afterwards, unwounded, but unable to
see or to move his legs. This may have been a hysterical reaction to an
unbearable situation, as was recorded in World War One. The soldier
could not cope with the fear of being in the midst of flashing swords,
jabbing spears and maniacal (but equally terrified) enemies, so he
refused to see it, and refused to take part in it. This was not a conscious
decision, but his body reacting to the trauma. According to Herodotus
the man never recovered his sight. Of course, Herodotus is considered to
be one of the Wests most unreliable historians, but the point is valid
whether or not the event took place. Some situations are so unbearable
our bodies find many ways of shutting down in order to cope, to stay alive.
Shakespeare, writing at the cusp of the seventeenth century, describes
several scenes reminiscent of modern-day conceptions of trauma.
Macbeth is a tale of trauma, but perhaps the best relating to war trauma
is in Henry IV, Part 1:
Tell me, sweet lord, what ist that takes from thee
Thy stomach, pleasure and golden sleep?
Why dost though bend thine eyes upon the earth,
And start so often when thou sitst alone?
Why hast thou lost the fresh blood in thy cheeks,
And given my treasures and my rights of thee
To thick-eyed musing and cursed melancholy?
This piece illustrates that the fundamental symptoms of traumatic stress

were present in Shakespeares time. Henry had just been to war, and may
now have been classified as traumatised. But see how the language has
changed? A modern Shakespeare might write:
Why, Henry, do you have an eating disorder and sleep disturbance?
Why are you depressed, experiencing symptoms of hyperarousal and
social anxiety?
Why are you anaemic, and why have you lost your sex drive,
And why do you experience intrusive thoughts and depression?
Perhaps we will leave it to Shakespeare.

Half a century later, in 1666, Samuel Pepys recorded in his diary that,
after the Great Fire of London, he had nightmares for some months,
nightmares that are now considered to be one of the key representations
of traumatic memories. Along with the nightmares, he experienced the
range of symptoms: intrusive images, feelings of detachment, memory

impairment and survivors guilt (Daly, 1983). The fire must have been a
terrifying sight, eventually burning down a large proportion of Londons
mainly wooden houses in the old city, destroying St Pauls cathedral and
killing an unknown number of people unknown because there was no
accurate census of the people living in the city at the time, and a fire of
that heat would have entirely obliterated bodies caught up in it. At one
point the fire threatened Pepys house. He kept his gold in the cellar and
a cynic might argue that his nightmares were more about the possibility
of losing his gold than his house or his life.
Nightmares were also described by Charles Dickens after he helped
the victims of one of the earliest train crashes in England. The problems
associated with railway injury, including psychological symptoms, were
acknowledged in law, through railway spine, a disorder recognised in
people who had been through train crashes (Erichsen, 1866). Railway
spine was noted for the shaking or jarring of the spine, and initially
people might not have noticed they were injured because they felt
confused, but once they got home, he bursts into tears, becomes
unusually talkative, and is excited. He cannot sleep, or if he does, he
wakes suddenly with a feeling of alarm. As a reminder that there is
nothing new, litigation against railway companies during the Victorian
era often used railway spine as evidence.
The essentially random nature of battle you cannot predict with any
accuracy where the bullets and shell components will be travelling has
led many soldiers to acknowledge the instability of life. This affected
soldiers in different ways. Those best able to cope were those who could
accept that life and death in battle has a lot to do with chance and one
may as well be fatalistic about it. Those who failed to cope may well have
developed psychological problems. The difficulty we have from this
distance is understanding these problems, as the language of trauma
has changed. We may read of soldiers committing suicide and assume
that they were traumatised. William Surtees, a British sergeant during
the Napoleonic wars, described feeling sick in heart and body when he
witnessed the mass shooting of prisoners. He called his feelings unpleas-
ant sensations; that is how much language has changed in 200 years.
French soldiers of the same era who displayed symptoms that resembled
what we now might call PTSD were labelled as having nostalgia. It was
thought that their symptoms far from being related to the fear of being
shelled, shot at or stabbed by a bayonet or hacked by a sword resulted
from the soldiers missing their mothers and sweethearts!
Reid (2000) describes traumatic stress reactions during the Crimean
War. Sergeant-Major Smith describes the aftermath of the Charge of the
Light Brigade, and how a round shot had taken off the arm of one of his
comrades, leaving his own arm splattered with blood. The descriptions
are quite detached, and Reid describes how this indicates a numbing of
responsiveness, linking it to the PTSD criteria of diminished interest,
restricted range of affect and feelings of estrangement. Bombardment
often plays a key role. Major Henry Clifford described how shelling
made a great impression on soldiers nerves, and that it was a trying
thing to sit idly by while being bombarded. Again, note the use of
language. Major Clifford also noticed how bombardments could affect
sleep patterns, how his tent-mate developed restlessness under night
bombardment and shooting. The Russian view of the Crimean War
was well described by Tolstoy in his recollections of the time he fought
against the British. As a novelist, Tolstoy spent time describing the
impact of a shell landing close to an officer, and how the soldiers spirit
went from life through death to utter oblivion (Reid, 2000). Another
example provided by Reid is that of Colin Campbell, who developed
symptoms of PTSD during the Crimean War. His letters showed that he
became destroyed emotionally as he was experiencing traumatic events
on a daily basis. He became desensitised to the death around him, and
he failed to experience a great deal of feeling even when he heard about
his sisters death. This is a classic case of emotional numbing. Campbell
described the different reactions of the soldiers, highlighting that during
one of the attacks, a good many of the men did not behave well; this
looks euphemistic to modern eyes. Interestingly, Campbell explored
substance abuse, distinguishing between those who drank steadily all
night and performed their duty during the day and those who got very
drunk whenever they could and spent a lot of time in the guardhouse.
The latter tended to survive longer than the former; though perhaps that
was because they spent a lot of time in the guardhouse.
During the US Civil War in the 1860s, soldiers experienced psycho-
logical symptoms in and after battle. Oliver Wendell Holmes described
suffering the most intense anxiety during the early days. The psycho-
logical problems experienced by the common soldier were described
some years later by Da Costa (1871), who coined the term soldiers
heart, and explained the symptoms as resulting from soldiers having a
weak heart, that is they had a physiological problem underlying the
psychological symptoms. The idea that there must be a physiological
explanation for traumatic symptoms was usual in the nineteenth cen-
tury. Disorders were thought to be physiological, with physical causes
(and physical cures). It was not until the 1880s that people such as
Charcot, Freud, Breuer and Janet would open up the debate regarding
the psychological genesis of mental disorders. These authors produced
seminal works based on their clinical experiences. During the last years
of the nineteenth century and into the early years of the twentieth, they
fundamentally changed our understanding of traumatic stress, moving
from the physiological origin to the psychological one, recognising that
psychological and physical symptoms could arise from psychological
causes.
It was not until World War One that the psychological genesis of
trauma was at least partially recognised by the military authorities in
the West, particularly through the work of people such as Rivers, who
treated Wilfred Owen and Siegfried Sassoon. It was recognised much
later than this in countries such as Germany and Russia, both of which
regularly shot soldiers who displayed symptoms of war trauma up until
the end of World War Two. In the UK we stopped shooting them after
World War One.
There was, of course, a long period where it was not clear whether
there were physiological or psychological causes of war trauma. During
the Russo-Japanese war of 19045, psychiatrists served near the front.
The Russians had learned from their experiences in the Crimean War,
where they had lost significant numbers of men to psychiatric problems.
The Russians had a psychiatric hospital at Harbin where they treated
2,000 psychiatric casualties. Unfortunately the Russians wrongly attrib-
uted psychological symptoms to physiological injury a problem to be
repeated in the First World War. Nevertheless, this was the first war in
which psychological reactions to the heat of battle were recognised
(Baker, 1975). The symptoms formed the basis for the classification
systems used in the First World War.
Hesnard (1914) reported psychological effects resulting from the
sinking of the French ships Liberte and lena at Toulon in 1911 and
1907. These conformed to PTSD-type symptomatology: intrusive
images, nightmares, anxiety, avoidance, somnambulism, hypervigilance,
lack of concentration, and amnesia. It was becoming clear by this stage
that there were a number of symptoms that tended to co-occur after a
traumatic event.
Throughout the historical periods discussed there was never a wide
recognition that men could experience psychological problems in battle;
apart from the letters sent home (and these were only written by the
educated and the literate) it was rare to recognise the reality of psycho-
logical trauma. There would have been many examples of psychological
breakdown; it is just that few people wrote about it. Generally, if some-
one experienced symptoms in battle they were usually seen as cowards,
and would often be executed. This applies across cultures and across
historical time periods. Breaking down in battle has always been seen as
a weakness on the part of an individual rather than as a sensible reaction

to extraordinarily frightening events. It was not until after World War
One that people wrote about war trauma openly. The poems of Wilfred
Owen, or Remarques All Quiet on the Western Front, are classics. Even
now, when we have a hundred years of psychological theory which
conclusively proves the general nature of the traumatic response, break-
ing down in battle is still seen as a weakness. This is perhaps inevitable
given that soldiers have to be trained to fight in very dangerous conditions.
Without this training, without the macho culture, it would be impossible
for anyone to go to battle a classic paradox for the armed forces.
In World War One the British Army authorities executed over 300
soldiers who were accused of cowardice in the face of the enemy or
desertion. The case for these men was expounded in detail by Babington
(1983), a lawyer who claimed that the men were suffering from psycho-
logical trauma in the face of overwhelming circumstances in battle. These
men have now been pardoned. This is an excellent example of how
modern ideas have been imposed historically to change history. These
men were sentenced at a time when the law clearly stated that the sentence
for cowardice or desertion was death. War trauma or PTSD was not
recognised in law, and was not considered a defence. To be frightened
so much that you could not face the enemy was cowardice, and that was it,
according to the authorities. It does remain questionable whether deci-
sions made in one era should be overturned nearly a century later, when
conditions are very different. Look at the spate of apologies issued by
countries leaders in the last few years. What is the point of apologising for
something carried out by different people in an era largely unconnected
with our own despite our still living with the consequences of the events
of history? It is agreed by most people that Tony Blair acted illegally
in sending troops to war in Iraq in 2003, and there is a good case for
him being tried as a war criminal under international law, but he is not
responsible for African slavery in the seventeenth century.
Nevertheless, it is a difficult decision, perhaps with no right answer,
illustrating the interlinked nature of cultures. With respect to the First
World War, the opinions and attitudes of the first decades of the century
were very different to those of today.
At the outbreak of the First World War psychiatric services in the UK
were very limited, but the war led to major advances (Lipgar and Pines,
2003). Before the war there were very few psychiatrists attached to
the military. There was an asylum at Netley for troops who had mental
disorders such as depression or psychosis. Generally speaking, the less
serious mental disorders were treated by non-specialist doctors. Once war
broke out there were people who did not believe there would be a problem.
Dr Albert Wilson stated that I do not think psychologists will get many
cases (quoted in Jones, 2004, p. 92). But it quickly became clear that
soldiers who were repeatedly exposed to bombardment could experience
an emotional breakdown, and it was debated whether this was caused by
microscopic damage to the central nervous system (literally, shellshock),
or whether it was a psychological problem. The term shellshock was
popular during the First World War (Salmon, 1921). Charles Myers, a
doctor in the Royal Army Medical Corps, described the condition of
emotionally disturbed troops arriving back from France in 1914 as shell-
shock. It was thought at the time that soldiers brains had been damaged
by exploding shells, that the forces of compression and decompression led
to microscopic brain haemorrhage. It was also thought that carbon mon-
oxide from the blast might contribute to cerebral poisoning (Jones, 2004).
Articles began to be published on the subject. These were summarised by
Salmon (1921) in his post-war report on shellshock, by which time it was
widely recognised that shellshock was a psychological disorder, not a
physiological one.
In order to best understand the traumatic response of the soldiers of
World War One, it may be most appropriate to turn to the poetry and
literature of the time. Both Wilfred Owen and Siegfried Sassoon experi-
enced shellshock during World War One and were sent to Craiglockhart
hospital outside Edinburgh for treatment, though Sassoon was actually
sent there for criticising the Governments war policy perhaps demon-
strating his sanity rather than his insanity. It was that or be tried for
treason, and the Government did not want that. The decision to
send Sassoon to Craiglockhart was, unfortunately, political rather than
medical. The best-known doctor at Craiglockhart was undoubtedly
W.H.R. Rivers (1922), who treated both Owen and Sassoon, and who
told his story in his autobiography after the war. The Regeneration
trilogy of Pat Barker, published in the 1990s, provided a vivid account
of the experiences of the traumatised soldiers in Craiglockhart. Rivers
was a strong advocate of the psychological cause of shellshock, believing
that part of the problem was that civilian soldiers, who had been trained
quickly, had been unable to build up effective defences against the
intense emotions they were to experience as a result of trench warfare.
Rivers believed, like Janet (1925) in Paris, in a cathartic approach, and
in attempting to reintegrate the traumatic experience into consciousness.
Wilfred Owen illustrated both cognitive processing and avoidance
through his poetry. In this instance, he shows how soldiers commonly
used avoidance in relation to the deaths of their fellows:
Why speak not they of comrades that went under?

Hibberd (1992) claims that only soldiers would see the point of this
question, because only soldiers have the memories of their experiences.
Owen states that soldiers have problems with the emotions associated
with memories of dead comrades and so they avoid thinking about them.
Through literature we can gain an understanding of war experience,
again in the words of Owen regarding battle:
I can find no word to qualify my experiences except the word SHEER . . .
it passed the limits of my abhorrence. I lost all my earthly faculties, and
fought like an angel.
Owen recognises the traumatic nature of the war, that to experience war
is to experience something entirely alien to normal behaviour, and
something that is not possible to describe.
Not all medical practitioners were as enlightened as Rivers. Lewis Yeal-
land became renowned for his physical treatments. He used Faradism,
basically electric shock treatment, to cure paralysis. Yealland, not unlike
many senior military officers, believed that soldiers with functional symp-
toms had weak wills and that they needed strict discipline and harsh
methods to be cured. While he claimed a high success rate, this was likely
to be due to fear on the part of his patients. Patients experienced what
we might now view as torture. One man was strapped in a chair for
20 minutes at a time while strong electricity was applied to his neck and
throat; lit cigarettes had been applied to the tip of his tongue and hot
plates placed at the back of his mouth (Jones, 2004). The patient had
been told he could not leave the room until he was cured 4 hours of
electric shocks did the trick, according to Yealland (Binneveld, 1997).
The change in the idea from trauma being viewed as a psychological
disorder with environmental causes rather than a physiological one was
the fundamental change in thinking that enabled future psychologists to
make progress in understanding and treating war trauma. Prior to World
War One, the physiological argument reigned supreme. After the war,
many accepted that an environmental event could be the cause. This was
a Kuhnian paradigm shift that had been building up since Charcots
work in Paris in the 1880s, and was forced through by the unbearable
horror of the trenches. Of course, even by the end of the war there was
still strong disagreement about the existence of shellshock, with many
claiming it did not exist as a disorder at all.
During the war, psychiatric battle casualties had been initially
returned to the UK along with the wounded, but by the end of 1915 it
was clear that the chances of a soldier being cured decreased the further
they were sent from the front line. It was Myers who first suggested that
the troops should be treated relatively near the front line, but far enough
away so that they were safe. Sir Arthur Sloggett, who had the rather long
title of the Director-General of Medical Services of the British Armies in
the Field, agreed that Myers could open specialist psychiatric units in
casualty clearing stations about 10 miles from the front. Sloggett himself
was against psychological treatment, believing that shellshock could be
treated with military discipline. Nevertheless, four treatment centres,
termed NYDNs (not yet diagnosed nervous) were established (Jones,
2004). The soldiers were rested and given encouragement to recover. This
strategy was later described as PIE proximity, immediacy, expectancy
the basic principles of treatment for battle stress:
Proximity The soldier must be treated as close to the front line as
practicable.
Immediacy He must be treated as soon as the symptoms appear.
This relies on his officers being aware of the symptoms, and
recognising them as traumatic stress rather than as signs of
cowardice.
Expectancy At all times the soldier must expect to return to his
frontline unit. If the soldier was allowed to think that he was a
casualty just like any physically wounded comrade, then the
symptoms would be less likely to dissipate.
This few hours or days bed rest meant the difference for many men
between breaking down completely and being able to cope. The dividing
line between clinical PTSD and sub-clinical PTSD is not that clear. PIE
probably helped many with sub-clinical disorders. The same issue arises
now: we make little effort to deal with those who have sub-clinical problems,
apparently not realising that by treating people before they have full-blown
PTSD we might save a lot of heartache and pain.
These principles, though sound, were not widely applied during the
First World War. After the war, when there were thousands of veterans
suffering from chronic psychological trauma, there was very little in the
way of effective treatment whether psychological or physiological
available. Most of the sufferers were left in mental institutions, and many
remained there for decades, never regaining their sanity, despite the good
work of many psychiatrists and psychologists2. The conditions persisted,
though many psychiatrists and others had believed that once a neurotic
soldier had been discharged from the armed forces he would stop his
subconscious malingering and recover.
2
These people were the unsung heroes of the interwar years, caring for many thousands of
forgotten heroes, often with little success, but with much perseverance and care.
Charles Myers ended up serving in France through most of the war.

When he was demobilised in 1919 he described how he was weary after
his service. He was invited to contribute to the Report of the War Office
Committee of Enquiry Into Shell-shock, but found that the revival of his
memories was too painful for him. When he finally wrote up his wartime
diaries in an account published in 1940, he found the experience of
preparing the book exceptionally unpleasant. Clearly, Myers had been
significantly affected by what he had seen.
In Austria, Sigmund Freud was applying his principles of psycho-
analysis to the treatment of traumatised soldiers. Freud (1921) was aware
that combat could lead to war neuroses. He suggested that there is a
conflict between the superego and the id, and that war neurosis is a
response to the horrors of combat, that there is a change in ego-state from
peacetime to wartime, with the wartime ego being threatened with anni-
hilation. Freud also recognised from the outset that war neuroses were
functional rather than organic, psychological rather than physiological,
which is in contrast to the allied First War World position which had
encouraged the notion of shellshock as a physiological response to combat
experience throughout much of the war. Here Freud was building on the
seminal work described earlier with Charcot, Janet and others in Paris.
After the First World War, the 1922 Report of the War Office
Committee of Enquiry Into Shell-shock recommended training medical
officers in psychological problems relating to war, but this was not taken
up with any seriousness. According to Jones (2004), the Journal of the
Royal Army Medical Corps only published five papers on shellshock
between 1920 and 1936. By the start of World War Two the treatment
principles discovered in the First World War had been largely forgotten,
because they had not been needed in the years of peace (Strecker and
Appel, 1964). By 1939 there were psychiatrists attached to the British
Army at the outset of the war but they were very few, and were in place
mainly to help select personnel for appropriate soldierly tasks. Before the
outbreak of war, the experts appeared to decide that war neuroses could
be abolished by pretending they did not exist. More specifically, any
problems that did arise were caused by an individuals inherited disposi-
tion, not the fault of war experience at all. This would be a good means
of reducing the burden of war pensions, and is still a tactic used today,
where soldiers who are clearly traumatised by their soldierly experiences
are considered to have a problem because of their genes or because of
some childhood trauma. Some preparations were made for psychiatric
casualties in the UK, particularly for civilians around the time of the
Blitz, but these failed to materialise when London was actually bombed
(OBrien, 1994).
Drug treatments had become available to treat war trauma;

barbiturates were used to sedate affected troops, to reduce the active
symptomatology. According to Sargant (1967) there is evidence for the
effectiveness of these treatments. It is certainly the case that after the
Second World War there were far fewer chronic war neurotics than after
the First World War, though barbiturates may not have been the only
answer. The nature of World War Two was different. Society itself had
changed fundamentally. The country as a whole was traumatised by
World War One. All the soldiers in World War Two grew up with their
fathers stories of World War One. That just could not happen again.
People would never respond in the same way.
William Sargant (1967) was one of the best known of the British
wartime psychiatrists. He described his experiences of British psychiatry
during the Second World War in his book The Unquiet Mind (Sargant,
1967). He worked at Belmont hospital near Epsom, and after Dunkirk
British soldiers began to arrive: I shall never forget the arrival of these
Dunkirk soldiers in their tin hats and filthy uniforms, some of them
wounded, many in states of total and abject neurotic collapse, slouching
along . . . Men swarmed into the hospital, some raging mutinously
against their officers for having deserted them in a panic and others
swearing that they would never care to fight again . . . Many were
suffering from acute hysteria, reactive depression, functional loss of
memory or the use of their limbs, and a variety of other psychiatric
symptoms, which one would never see in such abundance except during
a war (pp. 11415). Sargant then describes a case where a soldier had
hysterical dumbness, with hands shaking as though he had Parkinsons
disease, and paralysis of the bladder, which was enlarged up to his navel.
Sargant administered an intravenous injection of sodium amytal a
sedative he kept for experimental use on air-raid casualties. He described
the effect as startling. His bladder suddenly emptied, his speech
returned, his hands stopped trembling, and he became intelligent,
articulate and comparatively normal at least until the effects of the
injection wore off (p. 115). Sargant carried on using this treatment
throughout the war. The drug had an important side-effect. Soldiers
would suddenly remember details of their traumatic experiences.
After reliving these experiences, they often improved. Perhaps this would
have helped Hitler, who, in the First World War, was given a label of
amauro-blepharitis (hysterical blindness) but who had no sympathy
with traumatised German soldiers in the Second World War.
Another case Sargant describes was one where a soldiers brother had
been severely wounded. He had begged his brother to put him out of
his misery, which he did. The soldier then experienced a paralysis of
the hand which pulled the trigger. A sodium amytal injection resolved
the problem.
Sedation was used to keep patients asleep for days or weeks. At the
end of this period many soldiers would be much improved. (This was
also a technique which had been applied in the Spanish Civil War.)
Modified insulin treatment was also widely used, by both the British
and American forces (the latter used it with over 15,000 patients). This
treatment, which was effective with emotionally disturbed patients, but
not depressives, consisted of giving an insulin injection which made
the patient very drowsy, and just before they slipped into a (potentially
life-threatening) coma they were given plates of potatoes, which helped
restore glycogen levels to normality.
It has been estimated that around 1015% of the casualties sustained
by the British Expeditionary Force (BEF) during 1940 were psychiatric
cases (Keegan, 1976). Keegan also estimates that throughout the war
the psychiatric casualty rate varied from 2% to 30%, depending on the
conditions of the fighting, demonstrating the importance of the particu-
lar event, as well as the personality and resilience of the individual.
When the USA entered the war and became involved with major
fighting in North Africa, their authorities noticed that frontline units
were being rapidly depleted. Around 30% of all casualties were psychi-
atric ones. Psychiatric cases were being sent down the line and back to
the USA with the physically wounded. They quickly realised that they
needed fast and effective forms of treatment. They stopped sending
most psychiatric cases down the line and reintroduced the PIE principles
from the First World War. They also used the sodium amytal treatment
being used by the British. These treatments ensured that around 60%
of the psychiatric casualties could be returned to their units within a
few days. The USA failed to acknowledge the help the British
had given them regarding these treatments, claiming that their new
treatment narcosynthesis relied not only on sodium amytal or
Sodium Pentothal, but also on Freudian principles of psychoanalysis.
In 1943, General George Marshall, the US Chief of Staff, was still
complaining that more soldiers were being discharged on psychiatric
grounds than were being inducted into the army. During the whole
war 409,887 members of the US armed forces were admitted as psychi-
atric patients to overseas hospitals. Of these, 127,000 were returned
to the USA (Babington, 1983).
It was medical personnel from the USA who introduced the diagnostic
terms battle fatigue and combat exhaustion to try and remove the
stigma associated with war neurosis. There was a recognition that most
soldiers did not get used to combat; they put up with it for as long as they
could. Soldiers would become ineffective after around 140 or 180 days,
with the peak of effectiveness around 90 days.
The RAF used the term lack of moral fibre to describe war neurosis
in aircrews. Many airmen were labelled LMFs, due to the very high
casualty rates in Bomber Command. There was little support for aircrew
who experienced psychological problems. Some were grounded, around
one-third managed to fly again, and a very few were invalided out. The
social pressure is important here. Bomber Command experienced very
high casualties around 50% during the course of the war and the men
knew there was a limited chance of them surviving the war, so one way
out could be traumatic stress. Because of the need for large numbers of
trained aircrew, and a shortage of highly trained men, it would be
difficult to allow people to become traumatised in this group. It was
almost a throwback to World War One, with any signs of fear being seen
as cowardice. The stiff upper lip was at its stiffest under the moustaches
of the men of Bomber Command.
Later in the war, the large numbers of patients arriving after the
Normandy invasion ensured that Sargant and his team, now based at
Graylingwell Hospital, Chichester, would have to use emergency treat-
ments at a level that would be difficult in peacetime. Typically there
would be around thirty patients all being given the combination of deep
sleep and modified insulin therapy simultaneously. It was around this
time that Pavlovs work on classical conditioning became known in
Britain and new forms of treatment were tried. Sargant started encour-
aging abreaction by forcing patients not to relive their own traumatic
experiences, but an invented related experience, e.g. asking a tank-
man to imagine being in a burning tank trying to save a comrade.
In theory this led to an emotional release, after which the patient would
improve. This is similar to the imaginal processing now widely applied
as part of cognitive behaviour therapy.
Anderson et al. (1944) also described the condition of the men who
had broken down after the Normandy invasion. The soldiers were
labelled as having combat exhaustion, a controversial term which many
psychiatrists would not accept as the soldiers were not exhausted
on admission to hospital. Unfortunately some soldiers, learning the label
of their condition, convinced themselves that they were too exhausted to
leave their stretchers and that this would be a permanent condition.
Anderson et al. state that 12% were unable to speak, 8% were temporar-
ily blind, 7% had lost their hearing, and 15% developed a stammer.
None was affected by paralysis. Around 70% had nightmares about
their experiences. One difference between these men and those of the
BEF 4 years before was that these had not lost their morale no doubt
a function of the defeat of the earlier BEF and the expected victory of
the Normandy invaders.
Sargants wartime experiences led him, along with his colleague
Slater, to produce the classic book on psychiatric treatment, An
Introduction to Physical Methods of Treatment in Psychiatry. The Second
World War had seen an improvement in the methods used for treating
traumatised individuals. The treatment was designed to remove the
unpleasant memories and emotions of the traumatic event (Wilson,
1994). Dollard and Miller (1950) used combat as an example of learned
repression. They proposed that there are several stages of learning to
repress memories: (1) during combat there are many external and
internal cues; (2) the traumatic conditions attach strong fears to all these
cues; (3) afterwards when the soldier thinks about combat these
thoughts are the cues that evoke fear; (4) when he stops thinking, the
fear diminishes; (5) the decrease in fear reinforces stopping thinking, so
the veteran does not think about the war. These methods are again not
dissimilar to those used in modern treatments.
This chapter has provided an outline of some of the historical
moments in the understanding of war trauma up to the Second World
War. It is clear that the language of trauma has changed only recently is
it intelligible in modern terms and it is with difficulty that we interpret
the feelings of people who wrote letters home from battle before the mid-
nineteenth century. This has been a flavour of war trauma, a background
and context for developing our understanding throughout the twentieth
and into the twenty-first century. The next chapter takes up where this
one left off, with the research conducted during the Vietnam War which
led directly to the introduction of PTSD into the modern vocabulary
of mental illness.
3 Methods and ethics
Trying to understand and treat war trauma requires a good practical and
theoretical understanding of the subject. In order to obtain such an
understanding, effective methods must be used. Within psychology we
have developed a whole range of methods, from experimental through to
qualitative approaches; all can provide us with good theory, but in order
to do so they must be used appropriately. As in all science, there is good
and less good practice. It is not just that some methods are applied
inappropriately, with our ever-advancing technological and methodo-
logical understanding; researchers are constantly at the forefront of
new techniques and approaches, so it is inevitable that there will be
problems along the way. Another difficulty faced by trauma researchers
is that the work is often carried out in difficult circumstances, so com-
promises with regard to method are often made. It is difficult to design
the ideal experiment in a battlefield situation.
Another area of importance is that of ethics. While psychologists have
broadly conformed to ever more sophisticated ethical codes and proce-
dures over the last few decades, particularly in the West, there is an
ongoing debate about ethics, both in the protection of participants and
in ensuring the safety of researchers themselves. Ethical issues play an
important part in war trauma research. Inevitably, this research involves
some danger to both participants and researchers, and there are no clear
boundaries between what is acceptable and what is not acceptable.
Traumatised participants are often personally vulnerable, and there is a
possibility of further psychological damage occurring as a result of taking
part in a psychological study. We also must take care as researchers,
particularly when conducting research in war zones, though sometimes
participants can themselves present a danger to researchers trauma-
tised people can be aggressive and dangerous. These issues are conten-
tious, and it is important that we discuss them and act appropriately
when designing studies. It is equally important that we do not become
so rigid that a lot of good research cannot be conducted for ethical
reasons.
28
A range of methods 29
A range of methods
Researchers have used virtually every methodological technique avail-
able to the discipline of psychology, which is one thing that makes the
area exciting it is an area where we can genuinely triangulate research
from different methodological sources, and thus attempt to strengthen
our theories.
There are studies involving the so-called gold standard technique
of medical science the randomised controlled trial where the
researcher wishes to determine the effectiveness of a particular treatment,
e.g. cognitive behaviour therapy, and compare it with either another
form of treatment, or with a no-treatment control group. Traumatised
participants are randomly allocated to one of the groups, and after the
treatment is completed the groups are compared to find out whether
the treatment group has improved to a significantly greater extent than
the control group. If so, it is argued that, assuming all key variables have
been controlled for, the treatment is effective with this group.
Researchers have used brain scanning technology such as magnetic
resonance imaging (MRI) to explore those areas of the brain that are
thought to be important for war trauma, such as the amygdala (which
is involved with emotion and conditioning), the hippocampus (which is
important for memory input) and prefrontal cortex (involved with atten-
tion, decision making and working memory, all important in trauma
theory). By comparing traumatised and non-traumatised people, and
looking at the differences in brain structure or function, we can draw
conclusions about which areas of the brain are affected by trauma.
Other researchers use self-report questionnaires, which measure a
range of psychological variables, so we can see which variables play an
important part in how and why one person becomes traumatised and
another does not. For instance, we can measure extent of trauma, along
with age, sex, coping styles, social support and personality, and see which
of these predict a poor outcome after war experience.
Clinicians carry out detailed assessments of their clients throughout
a treatment programme. These can be used as the basis for case studies,
a method which allows the researcher or clinician to take a very detailed
look at the factors associated with trauma. These are illuminating to the
theoretician.
Interviews have been widely used as a method for the study of trau-
matised individuals because they enable the participant to discuss their
memories and feelings in detail, in the way they want to discuss it,
providing the information the participant wants to provide, i.e. focusing
on the issues that are important to them as individuals rather than the
issues the researcher thinks are important they may not be the same
thing. It is possible, through interviews, to develop a detailed under-
standing of the problems and issues faced by the person with war
trauma.
The narrative interview is a specific method linked to theory that is
important in this book. Narrative refers to a broad approach to a general
understanding of war trauma, and relates not only to the trauma itself
but also to the participants life in general, so providing a fuller and more
coherent picture of the role of the traumatic event in the persons
remembered experience. Narratives can be derived from a number of
sources, clinical interviews, narrative therapy, research interviews,
unpublished or published writings, etc., but if we are going to deal with
these we have to know how to carry out narrative analyses; we need to
apply a narrative method.
As in all science, understanding method is a critical pre-requisite for
understanding theory. Only by knowing how we studied an area can we
understand the potential strengths and weaknesses of a particular
theory. What follows is not a detailed consideration of each method
this is not a book on methods but an outline of some of the key issues.
Randomised controlled trials

While the randomised controlled trial (RCT) is the gold standard for
medical research, there have been relatively few of these trials carried out
within the field of war trauma. This is for a number of reasons, but there
is a need for further research in this area, as this will help us determine
the kinds of treatments that are effective for traumatised people. But
there is a problem. RCTs were devised for use in medical science, where
a specific drug is tested for efficacy in treating a specific disorder. The
science is clean, and largely free from confounding variables. A person is
randomly assigned to either the treatment (drug) or control (placebo or
no drug) condition, administered the treatment and then tested to see
whether there is any effect. Most (though not all) physical illnesses are
definable and discrete. They consist of a given set of symptoms defining
a specific syndrome. Unfortunately, war trauma is not like that. Each
person has a unique set of symptoms, some of which need to be treated
using different methods. There is not, and probably will not be, one drug
that will treat all of these various symptoms. The diversity of experience,
symptoms, personality and social settings makes it difficult to state that a
particular form of treatment is most effective. Treatment A may be very
useful for Person X, but not for Person Y, whereas Treatment B may
work with Person Y but not with Person A. Treatment C may be better
Randomised controlled trials 31
for dealing with startle reactions, and Treatment D for faulty beliefs.
It is complicated. Cognitive behaviour therapy (CBT) is recommended
by the NICE guidelines in the UK as the most effective treatment for
PTSD (NICE, 2005), along with eye movement desensitisation and
reprocessing. But CBT is only useful and effective for certain kinds of
people. Generally, they have to be people with some insight into their
condition, they have to be relatively intelligent in order to understand
how the treatment is meant to work, they have to be motivated to help
it work, and they have to be able to cope with the severe emotional
distress that will often result from the treatment. CBT will not work
for everyone.
Another problem with RCTs in this area is that they assume that a
patient can be randomly allocated to either a treatment or a control
condition. This is often just not possible. A lot of treatment for war-
traumatised people such as refugees takes place in the field, in the
country where the war is taking place, or in a refugee camp nearby. This
may not be the situation where an RCT can be used. People need
treating, and a war zone or a refugee camp is not always the best place
for exact science. Therapists have to be practical. One of the problems
psychologists working in this area face is criticism from the medical
community regarding the inadequacy of our methods. The situation
when treating traumatised people, especially in the field, is very different
from a hospital in a safe country where participants can be easily
accessed for the study.
This is also an ethical issue. If the clinician believes that a particular
treatment alleviates war trauma, and there is already some evidence that
this treatment works, then they may consider it their duty to use that
treatment. Refusing such treatment to psychologically damaged people
goes against the ethical principles of the professional psychologist. This
can sometimes be resolved if a waiting list control is used, i.e. where one
group receives immediate treatment, and the other group receives treat-
ment after a specific period of time. The key measurement is carried out
before the second group starts treatment. Again, while this is a good
experimental design, it may not be practical if the clinician is working
in the war zone.
Health service ethical procedures are at least in the UK very strict,
and there can be more emphasis on design matters than on ethics. That
may be appropriate in the hospital setting, but the problems faced by
psychologists should be recognised. As we can see from the above,
sometimes the most ethical solution for a study is to design it badly,
in terms of medical ethics. If this makes sense, the well-designed
study may be unethical while the poorly designed study may be ethical.
Any findings may be limited in scope because of the compromise, but

they will be helpful, and the study will still be scientific, if not quite as
methodologically rigorous as might be desired. The ethical procedures
for psychologists who are studying the complexities of human behaviour
should be separated from the procedures used for medical practitioners
testing drugs. The fundamental rules are so different that sharing the
same ethical procedure when studying patients is extremely problematic,
as we have seen in the UK over the last few years.
As an example of the problems faced by designing good RCTs, we
carried out a systematic review of the literature regarding the treatment
of traumatised refugees. We initially found around 800 studies looking at
the treatment of refugees, but once we had applied strict criteria relating
to the use of RCT the gold standard, remember we found that only
6 studies fulfilled the criteria. The reason that many studies had to be
excluded was that they were carried out in war zones or refugee camps,
or with groups of extremely distressed people. There is no time for
sophisticated techniques when there are damaged people. We found that
the most effective techniques were CBT and narrative exposure therapy
(Schauer et al., 2005). Both were significantly more effective than con-
trols. The problem with drawing a conclusion from this review is that it is
based on 6 studies rather than 800. An analysis of all 800 studies (but
recognising their limitations) might lead to a very different conclusion
regarding efficacy of treatment.
Other experimental techniques

A true experiment involves the manipulation of an independent variable
(the psychological factor that we are interested in, e.g. whether or not
the person has PTSD, or whether or not a rat has had its amygdala
lesioned) and the measurement of a dependent variable (e.g. the reaction
time to trauma-related visual stimuli, or the number of trials it takes a rat
to learn to avoid an electric shock). Participants should be randomly and
independently allocated to groups, so that potential confounding indi-
vidual variation (e.g. cognitive processing speed) is spread equally
across conditions. While true experimentation is difficult with much
research into war trauma, useful research has been carried out both on
the cognitive factors involved in trauma, and on work with animals,
particularly relating to conditioning paradigms and lesion studies.
Experimental work has played an important role in many ways, from
identifying particular brain regions that are important for emotional
processing and memory, to developing an understanding of the cognitive
problems experienced by traumatised people.
Brain-imaging techniques 33
Again, there are ethical difficulties when carrying out certain types of
experimentation in this area. Obviously, it is not ethical to traumatise
people and randomly allocate them to groups. That means that our
experiments on humans are generally quasi-experiments, where we
compare already traumatised people with those who are not traumatised,
attempting to match them according to traumatic experience and other
variables we consider to be relevant. We then test to see whether they
perform differently on, for example, a cognitive task (e.g. memory,
attention or perception). If there is a difference, we may claim that this
is because of the presence of PTSD. The problem is that the participants
effectively self-allocated themselves to the groups (due to their traumatic
stress). It may have been that the difference was already there before the
traumatic experience. We have no way of telling when we are working
retrospectively in this way.
There are further problems with experimentation in psychology
that are general ones, not associated specifically with war trauma.
Experimentation, by its nature, manipulates only one or two variables.
Humans vary on many thousands of factors, and so it can be difficult to
tease out an effect that is specific to the experimental design. When this
effect is small, as is the case with many cognitive tasks, then this can
become even more difficult.
Problems notwithstanding, experimental procedures have produced
some of the critical findings for our understanding of traumatic stress,
and these should not be overlooked. These will be examined in more
detail in the next two chapters.
Brain-imaging techniques
Brain imaging has become very popular in the last 20 years or so.
A plethora of technology is now available to look at what is happening
inside the brain, where it is happening and how activation in a specific
area of the brain is related to specific behaviours. This is a major advance
in psychology which is fruitful for theory and understanding. There is a
wide range of technology available, including magnetic resonance
imaging or functional magnetic resonance imaging, positron emission
tomography and computed axial tomography scans, and the newest
approach transcranial magnetic stimulation (TMS). All are invasive
techniques, particularly TMS, which involves deliberate stimulation of
specific brain areas and the analysis of the responses to that stimulation.
These techniques are used to help identify which regions of the brain are
active while people are displaying certain behaviours, or how the brains
of different groups of people (e.g. traumatised vs non-traumatised)
differ. They have transformed our understanding of the brain in the last
couple of decades. They have changed the whole nature of neuroscience.
This is a Kuhnian revolution in our understanding of the brain.
One of the problems with many imaging studies is that they only
show that activity is occurring in a certain area in the brain. This in
itself is not demonstrating a great deal. At one level these studies have
little more explanatory value than Galls phrenology, the measurement
of bumps on the head. The correlation between brain activity or size
and behaviour may be closer than Galls approach, but it does not go
much further than correlations. Fortunately, as we shall see in later
chapters, brain-imaging techniques, though they are still in their
relative infancy, have helped our theoretical understanding of trauma
enormously. We now have a far more detailed understanding of the
neuropsychological mechanisms underlying trauma than we did even
1015 years ago.
A good example of the kind of work that has been carried out in the
field of traumatic stress is that of Doug Bremner et al. (1995, 2005).
Since the 1990s this team has been trying to establish the important sites
relating to traumatic stress. Using PET, they have assessed a number of
different traumatised populations and consistently found that trauma-
tised people compared with non-traumatised people have a smaller
volume in the right hippocampus, an area of the limbic system that is
critical to the storage of explicit, verbal, conscious memories. This
finding is contentious, and other research has shown the relationship
to be more complex. Yehuda et al. (2006) found that veterans with
PTSD did not differ in hippocampal volume from matched veterans
without PTSD (though they did show lower urinary cortisol and poorer
memory performance on the Wechsler logical memory test and digit
span). Smaller left hippocampal volume was found in veterans who
developed PTSD in response to their first reported traumatic exposure,
compared with veterans who experienced PTSD after a second or
subsequent exposure. These researchers concluded that smaller hippo-
campal volumes may be associated with specific risk and resilience factors.
This is a demonstration of the difficulty of carrying out good experi-
mental research in this area. It is not clear from this quasi-experimental
study whether or not the veterans with a smaller hippocampal volume
had this before they were exposed to the trauma or whether it was caused
by the traumatic event. Teasing this apart is essential to establishing
causality. This demonstrates the need for longitudinal studies (see Jelicic
and Bonke, 2001) to establish hippocampal volume before exposure
to traumatic events, e.g. using samples of members of the armed forces
or the emergency services people who can be assessed at an early stage
Self-report measures 35
in their training, but who can be predicted to be exposed to traumatic

events during their career.
These relatively new methods are at an exciting stage, and both
methodological and subsequent theoretical developments are taking
place at a rapid rate. As yet there are still significant gaps in our under-
standing, particularly with regard to more complex processes, such as
narrative. These methods have not yet been effective at describing the
neuropsychological processes underlying narrative, as this involves com-
plex integration of comprehension and production. From the limited
evidence available, story comprehension involves a network of frontal,
temporal and cingulated areas that supports both theory of mind and
working memory processes (Marr, 2004). It is at the level of the integra-
tion of processes that researchers have not yet succeeded in analysing
the neuropsychology of narrative.
Self-report measures
The self-report questionnaire is probably the most common method
used in war trauma research, and the one that has the most problems
in practice if not in theory. There are a number of reasons why it is the
most ubiquitous method, and they are not always good ones. The
questionnaire, used well, can provide very useful information about a
person. Questionnaires are used to measure the type and extent of the
trauma, coping styles, social support, dissociation, anxiety, depression,
substance abuse, general demographic details (age, sex, socio-economic
status) and a host of other variables. Many of the measures used are
based on good psychometric principles. They have been standardised
using appropriate populations, and are reliable across time (assuming
the construct is stable across time) and measure (if there are two mea-
sures of the same construct). It is usual for a good standardised psycho-
metric instrument to have norms established so that a person can be
assessed against those norms. For instance, if we have a measure of
coping, we may be interested in knowing whether a person uses a particu-
lar coping strategy more, less or about the same as the average person.
Similarly, we need to establish cut-offs for many measures. If we want
to find out what proportion of people have PTSD after a particular
incident, then we need to establish an accurate cut-off so that we can
conclude with some confidence that people who score X or above are
likely to have PTSD, while those who score below X are unlikely to
have PTSD. We do not draw a firm conclusion from any self-report
measure. An assessment of PTSD or any other mental disorder requires
an in-depth assessment by a qualified clinician.
If a questionnaire is going to be useful, it must be based on sound

theory. For instance, if a researcher is going to accept PTSD as a suitable
description of the psychological response to war, that the medical model
is appropriate for the measurement of this, and that the diagnostic
criteria supplied in DSM and ICD are appropriate and accurately reflect
the symptoms experienced by a traumatised person, then the measure
used must be equivalent to a measure of PTSD; that is, it should assess
the event itself and the persons emotional reaction to it, intrusive
thoughts, avoidance and emotional numbing, hyperarousal, a temporal
component (how long the person has had the symptoms), and the
impact on work, family and/or social life. The items in the measure
should cover all of these. And many measures do. They have been
constructed according to these principles and work effectively. Both
researchers and clinicians use questionnaires extensively and effectively.
Problems with self-report measures

Unfortunately, there are a number of problems with self-report ques-
tionnaires and hence with many of the studies that have used this
technique. When reading the literature it is important to be aware of
these limitations and the impact they will have on the findings and
conclusions of a study. Here are some of the key problems.
There are too many measures

Many researchers appear to think that it is good practice when designing
a piece of research to make up their own measure, and call it after
themselves or the university or city in which they work. Many measures
that are presented in the literature do not appear anywhere else; they are
not used in further research. There may be little or no validation, nor any
clear justification for the development of the new measure. Psychology
as a discipline is in rather a mess regarding questionnaires; it is not
simply a problem for researchers in the field of war trauma.
It is difficult to estimate the number of measures available only in the
English language. And there are, of course, many available in other
languages, and translations of English measures in other languages.
These purport to measure a whole range of psychological constructs.
Some are well validated and have a lot of evidence to support their use;
others have little or no such support. Researchers should always try
to find good well-validated measures of the construct they are interested
in rather than try to make up a new scale just to add to the plethora.
On many occasions, researchers do not use measures that are
available, reliable and valid for other reasons. A measure might only be
commercially available, and be very expensive, or the researcher may

simply not know about it because of the sheer number of questionnaires
that have been published in the literature, and there are not always good
reviews of measures available.
Measures are not always based on good theory, or they

do not cover the full range of the theoretical construct
If there is no good measure available for a specific construct, then this is
when it is appropriate to develop one. Trauma theory is in flux. Though
we have a clear idea of the key concepts, new and revised theories are
being developed all the time, and a good self-report questionnaire must
accurately represent the theory it is attempting to measure, i.e. it must
have construct validity. If a researcher is interested in studying coping,
then there are several theories that propose anything from two to twenty,
or more, coping strategies. How should a researcher first of all decide
which coping theory is appropriate, and then which measure is the best
test of that theory? It is a daunting task, and one which the best research-
ers have not resolved. If we cannot agree a theory, then we cannot
(by definition) agree a theoretically sound measure.
Associated with the previous point is that a self-report

questionnaire may not cover the full range of material required
Assuming that we agree that PTSD is an appropriate theoretical
approach, then a measure of PTSD is appropriate for people we assume
have PTSD, but difficulties arise with war trauma for the reasons
described below.
First, the people in whom we are interested may belong to a non-
western culture, and if the measure is validated on a western population
it may not contain the necessary items for people from other cultures.
This is a common problem in war trauma research that has not been
resolved. PTSD is a western construct but wars usually take place in
non-western countries (even though most are backed by countries in the
West). We do not know the extent to which PTSD is applicable in many
countries. For instance, de Silva (2006) argues that the responses of
Buddhists in Sri Lanka to the tsunami of 2004 were very different to
classic PTSD, at least partly because Buddhists accept a version of
fatalism which is more accepting of events; hence there may be no
post-traumatic reaction because the event is not perceived as traumatic
in the first place. If there is no traumatic event, there can be no PTSD.
There may be similar psychological symptoms, intrusive thoughts,
avoidance, etc., but the overall pattern will not be the same, so a PTSD
questionnaire would not be appropriate.
Second, war trauma is more complex than simple PTSD. Not only do
war-traumatised people experience PTSD, they also have problems with
depression, anxiety, substance abuse, coping and social support a
whole range of problems so a measure of PTSD alone will not suffice.
Added to this there are specific issues relating to particular wars. For
instance, in the civil war in Sierra Leone, many males had their arms
chopped off, a traumatic incident not usual in war. In Bosnia, women
were systematically, politically even, mass raped. These kinds of inci-
dents must be accounted for in any self-report questionnaire that is
being used to assess war trauma, because one key part of war trauma
is the type of incidents that occur. This does not obviate the need for the
basic PTSD measure, but it does mean that there will often be adapta-
tions to existing measures in order to obtain full coverage of the material
required.
Measures may lack face validity, or be ambiguous to the user

There is little point in presenting a questionnaire for a person to
complete if they think that it bears no relevance to their situation,
no relevance to their experiences or their life. Psychology students in
the UK may be very used to completing questionnaires, but that is not
the case for most people in the world. A measure has to have face
validity: the person completing it has to believe that it is measuring
something worthwhile. If they do not believe this, then there is no
reason for them to complete it accurately, or at all. There are many
reasons why a measure may not have face validity. Many participants
will not be familiar with questionnaires, and why questionnaires are
used. To resolve this problem the person administering the question-
naire must show the participant that the information being obtained is
valuable and will contribute significantly to the research project, and
that the project itself is of value, particularly to the people completing
the questionnaire. Regarding content, the participant may not under-
stand why certain items have been included in a questionnaire. People
who produce questionnaires consisting of scales may deliberately
include unusual items, perhaps because they have useful psychometric
properties, such as detecting lies or a high itemscale correlation.
While such niceties are acceptable to psychometricians, someone in
a refugee camp may not appreciate their usefulness. We have to trust
the creator of the questionnaire to know what they are doing and to
have done a good job, which is not always easy in the war trauma
situation, where the participant may well see a questionnaire as
trivialising the issues.
The items do not have theoretical equivalence but

they are given mathematical equivalence
This is a problem common to most, if not all, psychometric question-
naires. A measure might have, say, twenty items. These items may cover
twenty different aspects of PTSD. The scale is scored on a 15 scale,
with 5 being high and 1 being low. The participants overall score is
obtained by adding up the number they record for each of the twenty
items, leading to an overall score of between 20 (very low) and 100 (very
high). The fundamental problem is that not all of the items have a
theoretical equivalence. An item on intrusive thoughts might be the
key item, which determines whether the person has PTSD, but it may be
scored in exactly the same way as an item on, for instance, having sleep
difficulties, which might be inconvenient but not a serious problem.
Items are not generally weighted according to the emotional significance
of the particular symptom that is being measured. This can lead to a
distortion of the final scores. This is linked to the next problem.
Each persons interpretation of what is meant by

an item may differ
One persons war trauma may be mainly about nightmares (and hence
sleep problems) whereas another persons trauma might be about intru-
sive thoughts during the day, whilst at work or with the family. Items
mean different things to different people. This, again, may distort the
overall figures obtained, and the questionnaire will not reflect the sever-
ity of particular symptoms for individuals. One solution to this is to
include a severity score for each item, so the participant can indicate
not only whether they have a symptom, but also how severe it is to them.
A related issue is how a participant scores a questionnaire

For instance, if there is a 5-point scale stating I am having nightmares
(the sort of item that does appear), then one person might put 5 when
they are having one nightmare a month. Another person will put 1 in
the same circumstances. Another person will put 5 because they are
having nightmares every night. Without actual behavioural markers
indicators to the participant about how to relate actual behaviour
to scores e.g. a nightmare every night 5, a nightmare once a
month 2, it is very difficult to ensure that self-report questionnaires
are filled in in the same way by everyone. A further complication, even
with behavioural markers, is that one nightmare a month may be a very
emotional event for one person, and a nightmare every night may have
fewer psychological consequences for another.
Specific items within the questionnaire may be interpreted

in different ways by the user and by the researcher
This is linked to the previous point. A researcher nave but normal
may assume that having a nightmare every night must be worse than
having an occasional nightmare. This will again lead to problems with
interpreting the questionnaire, if there is not more information
available.
Questionnaires are useful for group data but of little

use relating to an individual
There are circumstances where looking at group data shows something
of importance: the value of a therapy for a group, the role of PTSD in
war trauma, the extent of war trauma in a given population, or the
relationship between war trauma and particular individual variables
(coping styles, intelligence, etc.). What we must not do with question-
naires is, when they are self-report, extrapolate from the group to the
individual. Just because there is a group link which shows that people
with a processing coping style are less likely to have war trauma, this
does not mean that Person X, who uses a processing coping style, will
not have PTSD.
This has been a relatively long discussion because so much research is
based on self-report measures. It shows that there are a number of serious
deficiencies with self-report questionnaire measures that the researcher
must consider when devising their study. I hope that the above discus-
sion will not stop people from using questionnaires, nor from devising
their own, but it should show that care should be taken when choosing
this method. There are many pitfalls, some of which can be easily
avoided, some of which are difficult to avoid. Never take anything for
granted, even with a well-validated questionnaire. For instance, in one of
our studies (Hunt and Robbins, 2001a), Second World War veterans
completed the Impact of Event Scale (Horowitz et al., 1979) a
well-validated scale as one of the measures. Many veterans scored very
highly on the Intrusion scale, even 50 years after the war was over.
This showed that veterans experienced intrusive thoughts decades after
the war. However, another analysis of the individual items compared the
IES with other measures. It turned out that many of the veterans, rather
than demonstrating intrusion, were actually showing an interest in the
war. They liked talking about it, they liked reading about it and they
liked watching films. This interest was showing up in some of the items,
such as I thought about the war a lot. So even when there is a well-
validated measure, things can go wrong!
Interviews 41
Clinical assessment and case studies

This is one of the most effective means of developing trauma-related
theory. Case studies provide very detailed accounts of particular individ-
uals with war trauma. They may be cases that have been written up by a
clinician, or they may be individuals who have been extensively studied
by an individual researcher. They are usually presented in the literature
because they have something of particular interest. An individual may
have been through very difficult war-related circumstances and managed
to survive without serious psychological injury, or they may have
responded well to a new treatment, or they may have severe problems
which are of a different pattern to the norm. With regard to method,
data may have been collected using any of the methods already dis-
cussed, but it will include a detailed assessment, using appropriate
measures and interviews.
Clinical assessment is one area where there is a tremendous amount of
data that have not been written up, because the clinician may not have
time. There is a wealth of unpublished material based on evaluating and
treating patients.
Interviews
The interview is a very useful technique used widely by researchers.
The interview avoids many of the disadvantages of the questionnaire,
though it is, in its own ways, a potentially very imperfect instrument.
Interviewing comprises a number of techniques, from highly structured
(where there is a questionnaire to which the respondent provides
specific answers), to semi-structured (where there are open-ended ques-
tions, but the questions are still specific and there is a set order), to
unstructured rather a misnomer, but where there are a number of
topics the researcher wishes to address, and where the interview can flow
in different directions, depending on the way the respondent talks.
The researchers role is to ensure that the topics are adequately covered.
There are many different ways to analyse interviews. Analytic tech-
nique is the subject of many books, and it is not necessary to go into
detail here. There are many disagreements among psychologists not only
about how to conduct interviews, but also about how to transcribe them
and analyse the data. Some interviewers use content analysis a quanti-
tative approach where the analysis involves adding up the number
of times something is said and analysing these frequencies. More com-
monly, interviews are analysed using qualitative techniques, of which
there are many, for instance grounded theory (Strauss and Corbin, 1998),
interpretative phenomenological analysis (Smith et al., 2009), various

forms of discourse analysis (e.g. Potter and Wetherall, 1988), or narrative
analysis (Crossley, 2000; Burnell et al., 2006). All have their uses. Though
there are different analytic approaches, there are a number of general
rules underlying most techniques:
(1) Transcribe the interview carefully. According to the analytic technique
used, one may have to just transcribe relevant passages, or it may be
important to transcribe not only every word but also the pauses,
exclamations, etc., i.e. the non-verbal components. It is best if the
interviewer does the transcription, as he/she is more knowledgeable
about what happened during the interview.
(2) Pick out the phrases, sentences or paragraphs (units) that are meaningful,
i.e. the statements made by the participant that may be helpful
during the analysis.
(3) Group these units together in categories or themes. These categories or
themes should emerge as the units are grouped. They often emerge
as the researcher is extracting the materials from the original tran-
script. The units should be grouped and regrouped until a meaning-
ful structure emerges. This may involve over-arching themes and
sub-themes.
(4) Validate these themes. At this stage one should be able to write a few
sentences explaining what each theme represents. Do the themes
accurately represent the units?
(5) You should now conduct further interviews to validate the theme
structure, altering this structure as necessary as you carry out fur-
ther analysis. This continues until the categories are saturated, when
no more changes are apparent, and you have the most economical
framework of explanation.
(6) Write up using the themes as key discussion points. A straightforward
way to do this is to use the themes as subheadings, describe each,
and use appropriate (not too many) unit examples.
These are the fundamental principles, though researchers argue about
the relative importance of the style and depth of transcription, about
how to extract and group phrases, about how to validate the themes and
about writing up.
The interview, particularly the semi-structured or unstructured inter-
view, is a valuable tool for researchers interested in war trauma. Many
participants are upset by the use of questionnaires because they are very
restrictive and do not reflect their experience. War-traumatised individ-
uals are very sensitive to the meanings of their problems. They want to
put across the issues that are important to them in their own ways to
Narrative approaches 43
explore particular ideas, to look at how they have coped (or failed to
cope), their memories and their experiences. They want to discuss the
story of their war. A questionnaire is often seen as trivial, asking the
wrong questions. By devising an interview that has a number of themes
(e.g. the war experience, memories, coping styles), the researcher can
enable the participant to discuss what is important about these themes.
The researcher must be a good interviewer. They must be able to draw
out relevant information, even if the participant is reluctant to discuss an
issue. They must also be prepared to deal with the often raw emotions
that such interviews bring out in participants not just upset, crying and
bewilderment, but anger and sometimes aggression. The full gamut of
human emotion can be present in an interview with a victim of war trauma.
Narrative approaches
As narrative is central to this book, it is important that we examine
narrative methods. Narrative methods are used with a number of sources
of data, mainly the one-to-one interview, but written accounts (e.g.
diaries, journals, books) can also be analysed using narrative methods.
Narrative methods arose in part from the style of answer that many
participants made to interviewers questions. They typically tended to
be long-winded, and represented a fuller story than the interviewer had
actually asked for. There is a tendency for people to tell stories when
they are being interviewed, and it is every interviewers painful experi-
ence to hear such stories when they wanted just a short answer to a
simple question. Narrative methods had to be developed to take into
account peoples normal behaviour, which was to refuse to allow the
interviewer to fragment the coherency of their lived experience.
Of course, it was not that simple, but it is good to think that the ordinary
non-specialist has some power over the academic researcher.
According to Bamberg and McCabe (1998), human agency is critical
to narrative: people strive to configure space and time, deploy cohesive
devices, reveal identity of actors and relatedness of actions across scenes.
They create themes, plots and dramas. In so doing, narrators make sense
of themselves, social situations, and history (p. iii).
Mishler (1986) was one of the earlier proponents of a narrative
approach, though much work had been carried out prior to this. The
so-called narrative turn has affected many disciplines in one way or
another, for instance sociology, history, anthropology, law, social work
and, of course, psychology. Academics in each discipline have used
different narrative methods in their research, but this is not a full review
of narrative methods, so we will focus on methods used in psychology.
The difficulty with narrative methods lies in the complexity of the

subject matter. At the heart is the story, but what forms should the story
take? It can be anything from a clearly written account, to the jumbled
words of a traumatised person who is having difficulty in telling their
story because it is so painful. Often an interviewer will have a structured
set of questions that relate to the notion of story in general. Is this
appropriate or should not the person telling the story tell it in the way
they want? There is also the issue of the extent of the story. If we are
interested in trauma, then do we just want to hear the story of the event
and its direct consequences, or do we want the persons full life story so
we can understand something of the causal chain of events that led to
them being traumatised by their experiences? Stories are also intercon-
nected. A persons trauma story may be linked to their narrative about
their subsequent career, or their family relationships. The network of
narratives can extend out endlessly, so it is important that the researcher
has a clear idea from the outset about what kind of story they are looking
for. This, in turn, leads to another critical issue that storytelling is an
interpersonal exercise. The storyteller needs an audience, and the audi-
ence needs to make some sort of response. As psychologists, we are very
aware of the impact of someone in authority on the behaviour of others.
The researcher can be that person of authority to the narrator, and this
will affect the story that is told. Other aspects of the status of the
interviewer can affect the story told. When I was interviewing WWII
veterans (see Chapter 10), I was sometimes not made particularly wel-
come by veterans, who were only happy telling their story to people of
their own ilk, which generally meant other soldiers. However, when
they found out that I used to be a bricklayer, i.e. a proper mans job
(rather than an academic, which clearly is not a proper mans job), these
people were much more willing to talk.
Narratives about traumatic stress are much more than personal narra-
tives. As discussed in Chapter 1, trauma itself is not only psychological
it is interpersonal, social and political so it is inevitable that peoples
trauma narratives are going to contain social and political elements.
Narratives may be just as much about history and about politics, as
about the psychological state of the narrator. This brings in another
issue about the trauma researcher who is interested in narrative. It is
important that they understand the politics and the history that the
narrator is discussing. If they do not, then the narrator will be less willing
to put across their story. If the narrative is about World War Two, then
the researcher should know about World War Two both the historical
and political situation and also the social constructions that the narra-
tor is likely to hold because they are of that particular generation. This
Ethics 45
will be discussed in more detail in Chapter 10. The social constructions

held by any narrator must be understood by the researcher. Narrators
can position themselves as victims of their story, or as agents who assume
a level of control over events. The positionings of the self in personal
narratives indicate the performance of identity (Riessman, 2000).
The difficulty with narrative is the analysis itself, deciding exactly what
to analyse and interpret. The rules are not as strict as they are for
statistical analysis; they cannot be. Narrative analysis does not assume
objectivity but is concerned with position and subjectivity (Riessman,
2000), though some argue that large parts of any story can be factually
verified (Bertaux, 1995), though there is often little point to this. Verifi-
cation is usually more about matters of law than psychology. It is down
to the researcher to determine which elements, which segments of text,
are important and why. The researcher must interpret the text, and place
appropriate boundaries regarding the beginning and end of the story,
and determine the structure. This can be a complex task. In narrative
analysis this is sometimes carried out with the narrator, with the
researcher analysing and drafting the writing up of the research, and
then asking the narrator to comment on it. In the end, the narrative is
that of both the narrator and the researcher; and in this way is sometimes
criticised. Nevertheless, without the researcher imposing analysis and
boundaries the narrated story is less useful to psychological science.
Narrative methods have been criticised by many people, and it is true
that such methods are not appropriate for many types of research
(Atkinson, 1997; Atkinson and Silverman, 1997). If we need represen-
tativeness of the population, then narrative methods are not appropriate,
nor are they when it comes to understanding the neurophysiology of the
brain or cognitive mechanisms of memory. Nevertheless, narrative
methods are essential if we are to fully understand the response to
trauma, as narrative is itself a central part of that response.
Ethics
The researcher who is interested in war trauma will always come up
against ethical issues. All professional psychologists are bound by their
code of ethics, which means that they must ensure that the work they do
is within the bounds of their professional competence, that they do not
cause harm to others, and that they do not place themselves under
significant risk. The British Psychological Societys (2006) Code of Conduct
and Ethical Guidelines provides full details.
Any code of ethics presents problems to the researcher interested in
war trauma. By the very nature of the research we are asking people to
discuss those things that have caused them the most distress. By asking
them about their war experience we are deliberately causing them fur-
ther distress without even the promise of effective therapy. At the same
time the researcher is exposing him or herself to stories which might be
personally damaging. Furthermore, researchers who travel to war zones
can run significant personal risks. How do we deal with these issues?
Much of what follows is about interviewing traumatised individuals,
though the material is relevant for other methods.
Causing distress to the traumatised participant

It is almost inevitable that, during the course of the research, particularly
when the participant is being asked to describe traumatic events in
detail, a traumatised participant will become distressed. In a way, the
researcher is deliberately setting out to distress the participant, because
understanding the emotive nature of trauma requires an account of what
happened and how it made the person feel, think and behave. At first
sight, this may appear to contradict professional ethical guidelines, but it
is an inevitable consequence of discussing extremely distressing events.
There are several levels to resolving this problem. First of all, each
participant must provide full informed consent. The initial request for
participants to take part in the study must inform people at the outset
that they will be asked to disclose distressful memories. It is not enough
to provide them with the information after they have volunteered,
because many people, once committed, will feel they have to continue
with the study once they have volunteered, even though they might
prefer to drop out. They do not want to let down the researcher.
The second stage is about volunteering. If a person comes forward
after receiving information about the nature of the study, the researcher
must then tell them in detail what is required, and make it absolutely
clear that they do not have to take part. Sometimes this will mean
sending out the detailed protocol to the participant in the post, and then
hearing nothing back, not even a tick in the do not want to take part
box. The researcher should not pursue people. It is acceptable to send
one follow-up request, but the person must not feel hassled or forced
into agreeing to take part in the study. These are vulnerable people.
They change their minds about participation for their own good reasons.
The next stage, when the researcher meets the participant (who has
now signed consent forms), is to deal thoroughly with any questions,
before starting data collection, and to again make it clear that their
participation is voluntary and that they can withdraw at any time. If they
are still agreeable, the data collection takes place, with the participant
Ethics 47
able to stop at any point. After the data are collected, the researcher
should still ask whether the participant is happy for their information to
be included. The participant should then be provided with a list of
possible help points in case they have issues they wish to discuss further
(e.g. with a doctor or counsellor). The researcher should follow up the
meeting a few days later, just with a telephone call to make sure the
person is all right, to guide them to help if necessary, and importantly
for interviews to ask if there is anything they wish to add to what they
said. It is very common for people, after being interviewed, to think
about the issues over the next few days and either regret something they
said or want to add further details.
In the end, data collection with traumatised people is difficult for
the participants. They are likely to get upset; they are likely to cry.
While they should be free to stop the interview at any point, it is likely
to be more damaging to stop when the person is distressed than to
continue through the distress until they emerge at the other side.
There are added complications if the data collection is taking place in
a war zone or a refugee camp, perhaps with people who are not literate.
The rules stay the same; it is just that the method of dealing with the
rules changes. The researcher still has to obtain full informed consent,
and there should be no pressure on the person to take part in the study.
The participant must always be a volunteer. It is ethically questionable
to try to force people to take part in any research; it is particularly
unreasonable to ask traumatised people to discuss issues that many of
them do not wish to discuss. This does mean that samples are not
representative; it also means that any figures you obtain cannot be gener-
alised to the traumatised population. Owing to the nature of trauma,
there are some types of people who want to talk about their experiences
in details, and others who do not want to talk in any circumstances. These
differences must be respected, even though it means there will be a
methodologically and theoretically significant proportion of the popula-
tion who are not in your study, hence your findings may be biased.
These factors are a function of this type of research design compromise
before ethical compromise. As long as the issues are addressed fully,
including in the written report, this is still good science.
Self-exposure
The researcher who interviews traumatised people may experience
some symptoms themselves. When one constantly hears terrible stories
about death and cruelty, and about unbearable emotions, the stories
themselves can affect you. There is a whole literature on this. It is known
as vicarious traumatisation, and relates to both the effects on resear-

chers and on clinicians who treat traumatised people (Figley, 2005).
While the symptoms the researcher experiences are not symptoms of
trauma (they have not experienced an event, just a reporting of an
event), they can be distressing; and so it is important to be prepared.
First of all the researcher should be aware of the kinds of material
to which they are likely to be exposed. Second, while it is important to
demonstrate empathy with a traumatised person, the researcher should
not get too involved. It is important to stay emotionally detached from
ones participants. While this can be difficult, it must be achieved. It is
important not only for the research, but also for the researcher
researched relationship. The traumatised person would not expect you
to become emotionally involved; you are the one who exerts the control
within the relationship. The participant often appreciates the opportun-
ity to be open to someone with whom they have no emotional relation-
ship. In these circumstances they can talk openly and emotionally
without fear of hurting someone they know and care for.
Of course, some people will disagree, and argue that the interview is
between equals and that emotions should be shared and understood if
the interview is to be a success. While this viewpoint is relevant to many
interview situations, it is arguably less so when it comes to trauma. The
person who is traumatised needs help and guidance to be able to discuss
their problems not someone to share their misery. They want to feel
better after an interview, to have helped, to be useful. They do not want
the responsibility of upsetting the interviewer, and so, for this reason,
it is beneficial not to treat the interview situation as one of equals or
co-researchers, but of interviewer and interviewed.
Another issue for the interviewer is that of appropriate training in inter-
view techniques. An interview especially in this field is not a conversa-
tion. It needs structure and guidance. The interviewer needs to know how
to make progress in the interview, to cover the points required, to know
when a discussion is a blind alley or is likely to lead somewhere useful.
Finally, and perhaps most importantly, the researcher who is studying
trauma needs to have someone to talk to about their own feelings. Being
upset after an interview is perfectly human and normal, and it helps to
have someone to chat to about it, someone who understands, for
instance a co-researcher or supervisor.
Visiting war zones or dangerous places

Most researchers work for an organisation such as a university, and such
organisations have a duty of care towards their staff. This duty of care
means ensuring that staff are not put in any situation that increases their
Ethics 49
risk. Obviously, if a researcher visits a war zone, then they are putting
themselves at risk, so who is responsible for this? Any risk assessment
carried out in such a place would show very high risk on all categories,
and that would normally mean the member of staff should not visit the
war zone. If these findings were actually applied, then a lot of good
research would not get carried out. It perhaps illustrates one way in
which the health and safety culture has gone too far. While we want to
be reasonably healthy and reasonably safe, we also need some autonomy
in deciding what we consider appropriate. A university should never
force someone to work in a dangerous situation but, in the end, the
responsibility has to lie with the researcher. If they need to visit a war
zone for their research, then so be it. The employer should take reason-
able steps to protect the safety of the employee, but not to the extent of
banning travel for bona fide research.
Ethical issues a conclusion

In the context of ethical procedures for most psychological research,
there appear to be some serious problems for conducting research into
war trauma but, as we have seen, these do not present insurmountable
difficulties. A researcher should always design their studies with ethical
considerations to the forefront of their minds. This will, in areas such as
this, lead to design compromises. As stated earlier, this is better than
ethical compromises, and is still good science.
4 Current theory: post-traumatic
stress disorder
Introduction
This chapter focuses on our current understanding of war trauma. This
is a rapidly changing area, and space does not permit a thorough cover-
age of all theories. Instead, the focus will be on the key constructs and
the relationship between them. The area of war trauma is fascinating
because it is an area within psychology that allows us to draw together
the often disparate and contradictory perspectives, particularly psycho-
neurology, cognition, psychodynamics, behaviourism and social theory.
The purpose of the chapter, then, is not to provide a full theoretical
account of our understanding of war trauma, but to provide the scaf-
folding from which we can build that understanding. Chapter 7 focuses
on memory, particularly traumatic memory. This chapter discusses the
construct of post-traumatic stress disorder (PTSD), and associated
comorbid disorders. PTSD is the main classification that is used in the
diagnosis of war trauma, and it has been an effective heuristic, helping
bring about many thousands of publications on the subject. While it is a
popular diagnosis, and very useful for clinicians, there are some prob-
lems with it, and there is debate about the structure of the syndrome
(its symptoms have been revised with each revision of the diagnostic
classification system) and some question as to whether it should even be
retained.
PTSD
As described in Chapter 2, the construct now known as PTSD has
existed for many years under a variety of formulations and names,
mainly relating to battle experience (battle fatigue, combat neurosis,
etc.). These terms all refer to a specific set of symptoms that are the
result of a traumatic experience. In the twentieth century, interest in
the subject understandably tended to increase around wartime and
decrease during peacetime, though since 1980, when PTSD was itself
50
PTSD 51
introduced, there has been a plethora of papers and books published.

The PILOTS database (Published International Literature on Traumatic
Stress), which is designed for bringing together research on PTSD, lists
over 22,000 papers for the term PTSD (September 2009). It also has
295 publications for war trauma. The construct of PTSD has been a
useful heuristic for the generation of trauma-related research.
There are two key classification systems: the International Classifica-
tion of Diseases (ICD) and the Diagnostic and Statistical Manual of
Mental Disorders (DSM). Both have listed PTSD from roughly the
same time around 30 years ago and both have adjusted the classifica-
tion several times since then. They are largely consistent with each other,
and here we will examine the DSM, as it focuses specifically on mental
disorders. Both classification systems use the same coding system.
The original DSM-I was published in 1952 by the American
Psychiatric Association, and has been revised several times. DSM
was introduced partly on the basis of work carried out during World
War Two, to provide diagnostic criteria for mental disorders, and is
based on the key research for each mental disorder. Over the decades,
new disorders (such as PTSD) have been introduced, and old ones
have disappeared.
DSM-I recognised traumatic neurosis (American Psychiatric Associ-
ation (APA), 1952), which was classified as an anxiety disorder. DSM-II
was published in 1968, before the USA really recognised the psycho-
logical problems emerging from the soldiers returning from Vietnam.
The term trauma generally referred to physical trauma resulting in
psychological problems, e.g. problems arising due to a difficult birth or
to brain damage. People with psychological problems associated with a
traumatic event might be diagnosed with transient situational distur-
bance, which was an acute reaction to overwhelming environmental
stress. Here, if the symptoms did not diminish as the environmental
stressor diminished, then the diagnosis of another mental disorder is
indicated. Specifically, if someone reacted due to combat stress, then
they would be classified as having an adjustment reaction of adult
life, which was fear associated with military combat and manifested
by trembling, running and hiding (APA 1968) a rather simpler
definition than we now use.
The term post-traumatic stress disorder was introduced into DSM-III
(APA, 1980). This was largely due to the work of a number of authors,
particularly Mardi Horowitz, working with US Vietnam War veterans.
Since then, research has demonstrated that people have similar
symptoms irrespective of the nature of the traumatic event. DSM-III
recognised some fundamental changes in the way we classify mental
52 Current theory: PTSD
disorders. Instead of the broadly defined entities of earlier versions,

which looked at mental disorder in terms of a continuum from normality
to abnormality, DSM-III recognised that diseases should be symptom-
based and categorical (Mayes and Horowitz, 2005). PTSD was initially
a controversial diagnosis, argued over and debated for years. This was
partly because it related to a specific environmental event, unusual in
DSM (and necessary for a diagnosis of PTSD to be made), partly
because there was debate over whether it should be classified as an
anxiety disorder, and partly because the research findings relating to
the disorder were inconsistent. The stressor was classified in DSM-III as
an event outside the range of normal human experience; this referred to
war experience, natural and man-made disasters, rape and sexual abuse,
and other significantly stressful events. It was an attempt to differentiate
traumatic events from the more normal stressful events of life such as
divorce, losing ones job, or being in a fight. There was an assumption
that people should normally be able to cope with everyday stressors,
but not necessarily with traumatic events.
PTSD was revised for DSM-III-R (APA, 1987) and again for DSM-IV
(APA, 1994). A text revision of DSM DSM-IV-TR was later pub-
lished in 2000 (APA, 2000), with some changes to diagnostic categories.
PTSD lists the characteristic symptoms following exposure to an
extreme traumatic stressor not just war, but also rape, sexual abuse,
exposure to natural or man-made disasters, and other forms of extreme
stress. The diagnostic criteria are as follows:
Criterion A: The person has been exposed to a traumatic event in which
both of the following were present:
(1) The person experienced, witnessed or was confronted with an event
or events that involved actual or threatened death or serious injury,
or a threat to the physical integrity of oneself or others.
(2) The persons response involved intense fear, helplessness or horror.
Note: in children it may be expressed instead by disorganised or
agitated behaviour.
Criterion B: The traumatic event is persistently re-experienced in at least
one of the following ways:
(1) Recurrent and intrusive distressing recollections of the event,
including images, thoughts or perceptions. Note: in young children,
repetitive play may occur in which themes or aspects of the trauma
are expressed.
(2) Recurrent distressing dreams of the event. Note: In children, there
may be frightening dreams without recognisable content.
PTSD 53
(3) Acting or feeling as if the traumatic event were recurring (includes

a sense of reliving the experience, illusions, hallucinations and disso-
ciative flashback episodes, including those that occur upon waking or
when intoxicated). Note: in children, trauma-specific re-enactment
may occur.
(4) Intense psychological distress at exposure to internal or external
cues that symbolise or resemble an aspect of the traumatic event.
(5) Physiological reactivity on exposure to internal or external cues that
symbolise or resemble an aspect of the traumatic event.
Criterion C: There is persistent avoidance of stimuli associated with the
trauma and numbing of general responsiveness (not present before the
trauma), as indicated by at least three of the following:
(1) Efforts to avoid thoughts, feelings, or conversations associated with
the trauma
(2) Efforts to avoid activities, places or people that arouse recollections
of the trauma
(3) Inability to recall an important aspect of the trauma
(4) Markedly decreased interest or participation in significant activities
(5) Feeling of detachment or estrangement from others
(6) Restricted range of affect (e.g. unable to have loving feelings)
(7) Sense of a foreshortened future (e.g. does not expect to have a
career, marriage, children or a normal life span)
Criterion D: There are persistent symptoms of increased arousal (not
present before the trauma), indicated by at least two of the following:
(1) Difficulty in falling or staying asleep
(2) Irritability or outbursts of anger
(3) Difficulty in concentrating
(4) Hypervigilance
(5) Exaggerated startle response
Criterion E: Duration of the disturbance (symptoms in Criteria B, C,
D and E) is more than 1 month.
Criterion F: The disturbance causes clinically significant distress or
impairment in social, occupational or other important areas of functioning.
It must also be specified whether the duration is of less than 3 months,
in which case it is classified as acute, or 3 months or more, in which
case it is chronic. It is classified as delayed onset if the onset of
symptoms occurs at least 6 months after the event.
There is a good range of evidence in support of PTSD. A review by
Nemeroff et al. (2006) provide a good account of the literature. There
are individual factors that help predict PTSD (at least in groups).
Women are usually more likely to get PTSD than men. Kessler et al.
(1995), in a US study, found twice as many women with PTSD than
men. Frans et al. (2005) found similar results in a Swedish cohort. It is
not clear why women are more likely to be diagnosed with PTSD,
though there are a number of possible reasons. First, women are exposed
to different types of trauma, e.g. rape and sexual abuse, which may be
more personally violating, and hence more traumatic. Second, there is
the depression effect, whereby women are more likely to be open and
honest about their symptoms; they are more likely to go to the doctor
and report that they are experiencing problems than men. However, the
results are not clear, as some studies seem to show that PTSD rates can
be similar for men and women when they are exposed to similar events.
For instance, Kang et al. (2005) found that male and female US veterans
of the Iraq and Afghanistan wars have similar rates of PTSD. As Nemeroff
et al. (2006) discuss, female gender is usually a strong risk factor for the
development of PTSD, though the mechanisms for the disparity are
uncertain. There are other risk and resilience factors that help to predict
PTSD. The presence of effective coping strategies is a good predictor,
as is the presence of perceived social support, and previous mental
health conditions including PTSD (e.g. McCauley et al., 1997).
PTSD is recognised in British law, so people who have been trauma-
tised should expect to be treated justly according to the law because they
can get a diagnosis of PTSD. The Belmarsh 12 were a group of
individuals who were locked up without trial in 2002 because the British
government perceived that they were a terrorist threat. Usually recent
British governments have respected habeas corpus, and have not tended
to lock people up without just cause. A person is charged, and then they
are sent to trial, where it will be determined whether they committed a
crime and, if so, what the punishment should be. The Belmarsh 12 were
not charged, and were imprisoned without any knowledge of whether
they would be charged or when they might be released. A group of
psychologists and psychiatrists assessed them, and concluded that they
were experiencing PTSD as a result of the trauma of being locked up
without charge. In the end the courts recognised this and controversially
freed the men (Robbins, 2007).
PTSD has proved to be a useful diagnostic category for people who
are in need of treatment for traumatic stress. While the response to
traumatic events can be complicated, there are therapeutic procedures
that work with the symptoms of PTSD, at least for some traumatised
people. Providing therapy can benefit peoples lives by reducing their
symptoms. There are a range of therapies available. The NICE (2005)
Critique of PTSD 55
Guidelines recognise cognitive behaviour therapy and eye movement

desensitisation and reprocessing as the most effective forms of treat-
ment, though they do not work for everyone. If someone is to receive
psychological treatment, they need to be prepared for the possible
consequences of that treatment, and they need to be aware of their
own symptoms and be highly motivated to reduce them.
PTSD has also worked as an effective heuristic, helping to develop
research and theory about trauma. Without PTSD it is unlikely that
such a tremendous amount of research would have been carried out.
Research funding often relies on a clear description of a disorder, and
PTSD provided that label. As noted above, there are now many thou-
sands of scientific publications relating to PTSD, which have helped to
improve our understanding of traumatic stress.
Critique of PTSD
While PTSD has some very positive features, there are problems with
the construct. There is the complexity of the psychosocial response to
traumatic events. While people do consistently display the symptoms
described in DSM, the construct of PTSD is not entirely coherent or
consistent. Many, if not most, people with PTSD also experience other
diagnostic constructs, or symptoms from other such constructs. This
means that if we were to apply a medical diagnosis strictly, we would
have problems in recognising PTSD as a construct.
Many researchers and clinicians are critical of PTSD. At some levels
this does not matter. If treatments arising from a diagnosis of PTSD
work, then why should we worry too much? The problem is that PTSD
is, as stated earlier, recognised in law.
If a person can prove that they contracted PTSD as a result of their
working conditions they can sue their employer. If a diagnostic category
is going to be used in law, it must be as good at assessing disease as
possible. Rosen and Lilienfeld (2008), in a recent review, carried out an
empirical evaluation of the core assumptions of PTSD, and the results
were very critical of the construct. There were a number of key issues that
they addressed, starting from the position that PTSD rests on a number of
core assumptions, particularly that a class of traumatic events is linked to
a distinct clinical syndrome. This should, theoretically, distinguish PTSD
from other mental disorders. Rosen and Lilienfeld argue that, though
research has attempted to distinguish markers for PTSD, for example
biological or cognitive, it has largely failed to do so. In the end, the authors
conclude that virtually all of the core assumptions and mechanisms
relating to PTSD lack compelling or consistent empirical evidence.
Criterion A (p. 52) has always been difficult for PTSD. There is,
unlike most diagnostic categories, an assumption that there is a specific
environmental cause for the resultant disorder. There must be a link
between the traumatic event and subsequent symptoms. The key prob-
lems are that: (a) there is no clear definition of what a traumatic event is;
(b) it is not always possible to determine whether a traumatic event has
taken place; (c) it is not always possible to determine whether the event
actually produced the symptoms; and (d) the causal event is not neces-
sarily sufficient to lead to PTSD. Many usually most people, after a
traumatic event, are not traumatised. Criterion A has developed and
changed throughout the various editions of DSM in order to try to
clarify the first of these problems. Initially, in DSM-III, the event was
considered as something outside the range of normal human experi-
ence (American Psychiatric Association, 1980). This would immedi-
ately exclude war experience, the death of loved ones, and many other
traumatic stressors, and was clearly designed with the safe western
person in mind. In DSM-IV (American Psychiatric Association, 1994)
there is confusion between the event, which is something that leads to, or
threatens to lead to, death or injury, and the persons responses to the
event, feelings of fear, helplessness or horror. This confusion between
the event and the psychological response to the event is no improvement
on earlier versions of DSM. By confusing what happened with how
someone feels about it, the authors open the possibility of excluding
those people who experience the event, but who do not experience any
symptoms at the time or in the immediate aftermath, and who develop
symptoms at some future point. Perhaps this is why some people argue
that PTSD should not be linked specifically to a traumatic stressor.
Of course, there is the further problem with the stressor criterion
that some people develop a more positive and understanding outlook on
life after going through a traumatic event. This will be covered in more
depth in Chapter 6, but it is another reason why there is a problem with
the stressor criterion; such an event does not predictably lead to the
particular pattern of symptoms we call PTSD.
PTSD is defined within the traditional medical model of a number
of symptoms regularly clustering together and forming a coherent
syndrome. Unfortunately, there is no clearly definable group of symp-
toms that leads to a definite syndrome of PTSD. This may be a criticism
of the use of the medical model in these circumstances. The model may
be relevant to most physical disorders, and many mental disorders, but it
becomes problematic when considering complex psychological dis-
orders. Most research into PTSD has shown that there is nearly always
a comorbid disorder often depression, sometimes generalised anxiety,
Critique of PTSD 57
substance abuse, or aggression and violence-related problems. We

should question whether the medical model is appropriate when perhaps
90% or more of the people with a disorder have comorbid problems. If
PTSD is to represent a coherent clinical syndrome, any diagnosis must
show that it is not just an amalgam of symptoms that can be assigned to
other extant disorders (March, 1990). We should always seek out the
most parsimonious explanation for symptom patterns, and perhaps
PTSD is not the most parsimonious explanation.
The overall factor structure of PTSD has been critiqued, though
many studies support the three-factor structure represented in the diag-
nostic criteria (intrusive re-experiencing, avoidance and hyperarousal)
(e.g. Foa et al., 1995; Anthony et al., 1999), with others supporting a
two-factor structure (e.g. Buckley et al., 1998), The majority of people
have, according to Rosen et al. (2008), fitted a four-factor structure,
which is often labelled as re-experiencing, effortful avoidance, emotional
numbing and hyperarousal (e.g. Amdur and Liberzon, 2001; Simms
et al., 2002; McWilliams et al., 2005). If PTSD is to be an accurate
diagnostic category, then the number and names of these factors should
correspond very closely with the actual diagnostic criteria. This is not
clear, though the four-factor solution, separating avoidance and emo-
tional numbing, has been argued for on a number of occasions.
A further problem results from the variability of symptom patterns
observed in patients with PTSD. As Foa et al. (1995) noted, two people
may receive the same diagnosis of PTSD yet share no symptoms. This
occurs because there are seventeen symptom criteria, but only six are
needed for a diagnosis. While one person can report that they are experi-
encing intrusive thoughts, avoidance of reminders, an inability to recall
aspects of the event, irritability and hypervigilance, another might report
nightmares, a loss of interest in normal activities, emotional numbing,
sleep disturbance and problems with concentration (Rosen et al., 2008).
In the end, when critiquing PTSD, we always return to comorbidity.
Not only do the diagnostic criteria fail to combine particularly effect-
ively, except at the more holistic level, and not only do people present
with a range of different symptoms within the diagnostic category of
PTSD, but most people also receive a diagnosis of other disorders, such
as depression, generalised anxiety, or substance abuse. This problem of
comorbidity questions whether PTSD can be differentiated from other
disorders (Yehuda and McFarlane, 1995). If there are high levels of
comorbidity, then we can question the validity of the diagnostic
category; it simply is not functioning as an independent disorder. Rosen
et al. (2008), reviewing the literature on comorbidity, note that some of
the Criteria for PTSD are markedly similar to those for other disorders.
For instance, while criterion B-4 for PTSD is intense psychological

distress at exposure to internal or external cues that symbolise or
resemble an aspect of the traumatic event, Criterion A for Specific
Phobia is marked and persistent fear that is excessive or unreasonable,
as marked by the presence or anticipation of a specific object or
situation. Similarly, Criterion C-4 for PTSD is markedly diminished
interest or participation in significant activities, while Criterion 2-A for
Major Depression is markedly diminished interest or pleasure in all, or
almost all, activities most of the day, nearly every day. Again, intrusive
thoughts are considered to be critical to PTSD, but studies have found
that there is virtually no difference in intrusive thoughts between the
intrusive memories of depressed patients and PTSD patients (Rosen
et al., 2008, p. 845). While these similarities do not preclude PTSD
from being a viable diagnostic category, it can only be viable if the
diagnostic criteria themselves are stable, and as we have seen, they are
not stable.
There are further criticisms of PTSD the lack of distinctive bio-
logical markers (though there are such markers, as we shall see in the
next chapter) and the complications of traumatic memory but it is not
the purpose of this book to determine the ontological status of PTSD. It
is enough to say that there are problems with the diagnosis, and for the
purposes of the following discussion, the focus will be on war trauma as a
disorder, one that is not recognised in either DSM or ICD, but which
subsumes PTSD, depression, anxiety, phobias, substance abuse and
other problems that emerge as a result of the experience of war. The
complicated nature of war trauma has been recognised. Herman (1992)
draws a distinction between the disorder that arises as a result of a single
discrete event (simple PTSD) and that which arises as a result of long
and complicated events (complex PTSD). PTSD, as it is currently
represented in DSM, does not tease out the differences between
these disorders, though clinicians who treat PTSD have to in order to
effectively reduce the symptoms.
Whatever the arguments regarding the transition from DSM-II to
DSM-III, there is a continuum of response to a difficult event, ranging
from few or no symptoms, through some distress, to traumatisation.
While it can be argued that the continuum is broken at the point where
the response to the event is traumatic, the position is not clear. The
idea of a traumatic event involving some kind of rift is a good one, but
it is also problematic because many people after the event have such a
wide range of symptoms that it is difficult to determine which ones
should be classified as disordered. In effect, many people have sub-
clinical problems, but PTSD does not effectively separate the groups.
What are the symptoms of war trauma? 59
What are the symptoms of war trauma?

War trauma is not a recognised psychiatric entity, though there are
arguments for making it so. It is a complicated disorder, dependent
to some extent on the kinds of experiences people have during war.
Unfortunately, these experiences cut across the full range of traumatic
experiences, from seeing people die to killing them, along with apparent
man-made disasters such as the physical destruction of buildings, and
the maltreatment of people from rape through to starvation. People who
are traumatised by war are generally labelled as having PTSD, often with
some comorbid disorder such as depression or problems with aggres-
sion. The patterns of symptoms for someone with war trauma vary, but
they seem to depend at least to some extent on the particular war in
which the individual was involved, and the role they played (e.g. as
soldier or as civilian, perpetrator or victim, and the kinds of events that
happened). The pattern is not clear. People who are traumatised by war
display a wide range of symptoms that have some overlap, partly through
the PTSD classification, partly through comorbid classifications. The
symptoms can be more or less serious and last for shorter or longer
times. They may have a greater or lesser impact on the persons life,
depending on other factors, often beyond the persons control. The
symptoms themselves may be present for life. If a person becomes a
refugee, then there will be a significant environmental and psychosocial
impact. People who become refugees are often damaged more by their
arrival and reception in the new country than they are by the events they
witnessed or experienced in their homeland (Hunt and Gekenyi, 2003).
If we accept the medical model for mental disorders, then there is a
case for arguing that we need to have a diagnostic category of war trauma
distinct from PTSD, as PTSD covers only a proportion of the symptoms
experienced by people suffering from war trauma. Rather than take that
approach, we may help victims of war more effectively by using a
narrative approach that takes into account the breadth of their experi-
ence, the full range of symptoms they are experiencing, and by exploring
different ways to improve their mental and physical health through the
development of a narrative about their experiences which can involve
both traditional treatment and a wider range of activities. This can also
account for the more positive outcomes that indubitably occur among
many people as a result of experiencing war. This will be discussed in
detail in Chapter 6. Many people who have experienced war talk about
the excitement, the buzz, and about learning about themselves, and the
development of new skills that are useful in later life, and these experi-
ences are just as valid as the negative symptoms experienced by others.
An understanding of war trauma must take into account this range of

experience.
People with war trauma usually experience the symptoms of PTSD:
intrusive thoughts, avoidance, emotional numbing and hyperarousal.
They have difficulty in sleeping and in communicating with friends
and family, and they may also experience broader symptoms which do
not fit with PTSD, such as depression, displays of anger, substance
abuse or problems with relationships. The complexity of war trauma is
such that these symptoms may not always be present; the pattern
changes over time, partly as a result of the person dealing with their
memories, partly as a result of environmental and social changes.
There are added problems. Wars are not mainly about traumatic and
stressful experiences; they are about people living normal lives eating,
drinking, getting bored, having sex, being sent to school or college. Life
goes on, but it goes on differently. The person who has been through war
has experienced all these things so it is not surprising that when they look
back at their war they experience the full range of memories regarding
the war, not just traumatic ones. The problem for the more seriously
affected is that the traumatic memories are the ones that dominate, often
to the exclusion of everything else. What the person needs to do is to put
these traumatic memories in context.
Concluding comments
While there is much to say in criticism of the construct of PTSD, it has
proved to be very useful in guiding clinicians regarding the treatment of
traumatised individuals. It has also been an effective heuristic, generat-
ing a great deal of research around the world. Without PTSD, it is
difficult to imagine that our understanding of the response to traumatic
incidents would be anything like as good as it is now. Nevertheless, while
some people have argued the case for introducing a construct of complex
PTSD, the case of war trauma does show that there is a need to have a
broader explanation of peoples responses to such complex events as
war. The next chapter focuses on the role of traumatic memory in
enabling a deeper understanding of war trauma.
5 Approaches to understanding trauma
Theories of traumatic memory are in large part consistent regarding the

structure and processes involved in traumatic memory; though they tell
different parts of the story, they converge fairly well, even if there is
disagreement over the terms used. Traumatic memory is an area where
we can integrate work across different approaches in psychology, includ-
ing biological, cognitive, social and psychodynamic perspectives. This
chapter provides an outline of the different approaches, and how they
cohere.
Cognition and emotion

A great deal of research has been carried out to determine the impact of
trauma on basic cognitive processes such as attention and perception.
The findings indicate that people who are traumatised are more likely
to pay more attention to, and be more perceptually aware of, environ-
mental stimuli that remind them of the traumatic event than people who
are not traumatised. This is understandable from an evolutionary point
of view. If a person has experienced a traumatic event and survived, then
they will be programmed to respond quickly to similar environmental
stimuli and hence increase their chances of surviving again. The trau-
matised person is distinguished from the non-traumatised one in being
unable to separate the traumatic situation from the normal environment.
Attentional bias has been demonstrated through the Stroop test. The
original Stroop test consisted of the rapid presentation of colour words
that were presented either in the same coloured ink or in different
coloured ink. The participant has to say what colour the ink is, and their
reaction time is measured. When the colour of the ink is discrepant to
the colour word, the response time is slowed. Using a similar paradigm
with traumatised people, except for using subliminally presented
trauma-related words with the person naming the colour of the ink,
there is evidence for slowed colour naming (Harvey et al., 1996), and
also speeded reaction time to trauma-related words when using a dot
61
probe paradigm (Bryant and Harvey, 1997), i.e. a bias towards noticing
trauma-related words. Less positive results were found in an auditory
recognition test using traumatised Vietnam veterans (Trandel and
McNally, 1987). One of the problems with this type of research is that
traumatised people are not particularly conditioned to respond to words
it is particular sights, smells and sounds that they respond to so it is not
surprising that a task using words may generate conflicting results.
People experiencing a trauma experience a range of emotions,
depending on their own characteristics and on the type of traumatic
experience. As the first diagnostic criterion for PTSD includes fear,
horror or helplessness as concomitant to the event itself, it is not sur-
prising that there is a strong relationship between these reactions and the
risk of PTSD some time later (Brewin et al., 2000). Other people report
shame or anger at the time of the trauma. It depends on the person and
the situation. Another useful emotional concept is that of mental
defeat, which goes beyond the normal reactions and is concerned with
a breakdown of identity. This was demonstrated in former political
prisoners in East Germany (Ehlers et al., 2000). Those who experienced
mental defeat were still more likely to have PTSD many years later.
Mental defeat is a useful concept when discussing trauma and narrative,
as it indicates a total breakdown in the narrative that is difficult to
rebuild and restore.
The emotional response is also associated with peoples beliefs.
Emotions have to be at the core of any understanding of why we think
as we do. Janoff-Bulman (1992) argued that traumatic events shatter
peoples basic beliefs and assumptions about the world. Her view is that
we have fundamental beliefs that the world is meaningful, that it is
benevolent and that the self is worthy. Trauma disrupts those beliefs,
and recovery is about rebuilding them, or developing a narrative.
A similar notion was put forward by Bolton and Hill (1996), who
proposed a slightly different set of fundamental beliefs that the self is
sufficiently competent to act, that the world is sufficiently predictable,
and that the world provides a sufficient satisfaction of our needs. Again,
the traumatised person has these beliefs shattered.
Dissociation
Dissociation was discussed widely in the nineteenth and early twentieth
centuries, and has been revived in trauma theory. It is not clearly
defined, but relates to a breakdown of what is normally a relatively
continuous set of interrelated processes that help us to deal with the
world, whether that of the present, or the links between the past and the
Cognition and emotion 63
present. Dissociation may occur in traumatised people as a kind of

automatic coping mechanism.
Janet (1925, p. 597) showed that traumatised individuals have an unclear
verbal memory of the traumatic incident. He used the term psychological
automatism and suggested that the traumatic memory constituted images
and movements that were unconscious, but would, over time, begin to
encroach into consciousness. This leads to psychological symptomatology.
After a trauma, memories remain unconscious ideas until they have been
translated into narrative form through conscious action, or processing.
Janet discussed repression as a defence against traumatic memories
emerging into consciousness, in a similar way to how avoidance is used.
Memory that is persistently repressed becomes subconscious and lives
apart from consciousness. Dissociation thus results from repression.
Dissociation is experienced by a small proportion of the adult population
at any one time (Mulder et al., 1998).
Since the 1980s, research has moved quickly in the field of dissocia-
tion. Researchers have moved beyond the study of multiple personality
disorder to recognise, as Janet did so many years earlier, that dissociation
can help us to understand the mechanisms of the response to trauma.
For some, this follows the psychoanalytic tradition. Gardner (1997)
has argued that what he tortuously calls Embedment-in-the-Brain-
Circuitry Phenomenon is a contributory factor in the development
and perpetuation of psychopathology. Gardner argues that seemingly
purposeless mental material persists in brain circuitry for an indefinite
period of time, long after it serves a useful function. Similarly, but with
the apparent chaos outside, Sel (1997) argues that dissociation is a
consequence of adaptation to a chaotic environment rich in contrasts,
which is applicable to traumatic situations.
The impact of dissociation is that people will not be able to fully access
their memories. In extreme cases, dissociative identity disorder may
result, previously known as multiple personality disorder, but this is
rare in trauma cases. The kinds of symptoms that are normally experi-
enced include emotional numbing, depersonalisation and getting stuck
in the past. They relate to the severity of the perception of the traumatic
experience (Holman and Silver, 1998). When dissociation occurs at the
time of the traumatic event, it is known as peri-traumatic dissociation,
and it is closely correlated with later PTSD (Murray et al., 2002). The
symptoms tend to relate to the freeze that occurs in animals, rather
than the typical fight or flight response to a stressful situation.
Bremner and Brett (1997) noted that PTSD patients (Vietnam vet-
erans) reported higher levels of dissociative states at the time of combat-
related traumatic events than non-PTSD patients. Other authors have
found similar results (e.g. Shalev et al., 1998). Michaels et al. (1998)
found that dissociative states were more likely to persist in PTSD
patients.
Cognitive processing
A cognitive processing model of trauma proposes that a person enters a
traumatic situation with pre-existing schemata about the nature of the
world, their belief systems, and expectations regarding the future. The
experience of trauma confronts individuals with information that is
inconsistent with these schemata, which contain information about
safety and invulnerability. Horowitz (1986) argued that, for recovery to
occur, the individual must process the traumatic experience such that
the new inconsistent information is resolved and incorporated into the
persons schemata via a process of adaptation. In order to do this,
the pre-existing schemata must be adjusted to incorporate the new
information. The individuals attempts to assimilate the trauma-related
information will inevitably lead to increased arousal and hence a desire
to escape from, or avoid, thoughts and reminders of the event. Horowitz
argued that until the trauma-related information is assimilated, it is
stored in active memory, and will continue to produce intrusive recol-
lections. Psychological numbing of responsiveness is a psychological
defence mechanism against such intrusive thoughts.
Creamer et al. (1992, 1995) argued that there is little empirical evi-
dence to support Horowitzs work, and so presented a general model of
cognitive processing in a way that would allow for longitudinal empirical
testing (see also McFarlane, 1992). Their model is an attempt at a
synthesis of previous models, but it has the limitation that it fails to
include many elements that affect post-trauma adjustment, such as per-
sonality, social support and biological factors. It consists of five stages:
Objective exposure
The severity of exposure to the event has been found to be a critical
factor in the development of subsequent pathology (e.g. Foy et al., 1987;
Speed et al., 1989). But the severity of the stressor is not the only
determinant. The model proposes that the effects of the stressor will
be mediated by processing variables. These processing variables are
intrusion and avoidance.
Network formation
This can only happen if the person subjectively appraises the event as
being traumatic. The formation of the traumatic memory network in
Cognition and emotion 65
implicit memory will be determined by characteristics of the traumatic

experience (stimulus, response and meaning propositions). It will also be
affected by factors such as pre-trauma personality and prior experiences.
Intrusion
The memory network must be activated for processing to take place
(Foa et al., 1989). This occurs when the person is presented with infor-
mation that matches stimulus, response or meaning information in the
memory network (i.e. a reminder). Activation of the network results not
only in intrusion but also the accompanying aversive responses. These
intrusive memories, while causing distress, may also relate to cognitive
processing. Exposure allows stimulusresponse connections to be
weakened and encourages modification of the meaning associated
with the incident. Intrusion can be functional in this way, or it can be
dysfunctional, perhaps because it can result in very high arousal and can
prompt attempts to avoid the traumatic memories. Creamer et al. (1992)
conceptualise avoidance as a coping mechanism that is activated when
intrusive thoughts become too difficult for the person to deal with.
Intrusion leads to the automatic fear response, which is too strong for
the individual, who reverts to a strategy of avoidance; thus no processing
of the traumatic information takes place. Creamer et al. propose that
resolution occurs not only through intrusion, but also through more
adaptive processing, e.g. discussion of the trauma with family and friends.
Avoidance
Avoidance is a coping strategy, a response to the discomfort caused by
the intrusion stage. Network activation produces a state of high physio-
logical arousal. People may attempt to escape this by avoiding reminders
of the past. Our work (Hunt and Robbins, 2001a) suggests that avoid-
ance can be a very successful long-term coping strategy for some indi-
viduals. Creamer et al. (1992) argue that it can be maladaptive if relied
on to excess. They suggest that high levels of avoidance will be associ-
ated with the continued presence of psychological symptoms. While this
is true, it is also the case that avoidance may be a very effective strategy
for people for life. It is difficult to determine whether someone is
using avoidance effectively or whether they really do have no potential
symptoms. This presents another methodological difficulty.
Avoidance levels will also be determined by prior coping strategies.
While avoidance may successfully alleviate symptoms, traumatic infor-
mation cannot be processed. Creamer et al. predict that high levels of
avoidance will be associated with continuing symptoms. This stage is
critical for combat veterans. During combat, individuals use avoidance
as an important coping strategy. After World War Two they were told to
forget about what they had done, and wives were discouraged from
talking about it. But evidence, even from the 1940s, suggests that those
who avoid discussing a trauma may have more severe longer term
consequences (Lindemann, 1944).
Outcome
Recovery is achieved through activation and modification of the fear
network. This is evidenced by high levels of intrusion, which lead to
high levels of symptomatology at the time, but reduced symptomatology
later.
Creamers theory has had some influence on the development of
trauma theory, but there are difficulties. One of the biggest problems is
that it is difficult to test because it requires detailed longitudinal work,
and peoples complex reactions mean that they may be in several of the
above stages at any one time. Those who have apparently achieved
outcome may revert to earlier stages when they are reminded of their
traumatic event. It may not make sense to think of people being in
particular stages of recovery at all.
Another difficulty concerning processing is that it is assumed that,
when the memory network is activated, it automatically begins process-
ing. There is no reason to suppose that this is the case. If an individual
simply goes over and over the memory, it will not necessarily become less
horrific or traumatic. This is simply depressive rumination. As Weine
et al.s (1995) victim of ethnic cleansing stated, the memories may be like
films played over and over again. Another problem is that recovery is
oversimplified. In learning terms, the model suggests that a kind of
behavioural flooding takes place, and that if the person has high symp-
tom levels, then these will reduce over time through a process of extinc-
tion. There is no evidence that this is the case. In order for recovery to
take place, the individual has to act on the memories. This is where the
link with the work on explicit and implicit memories and developing a
narrative is important. Creamers notion of processing is equivalent to
the development of the narrative (van der Kolk and Fisler, 1995): if
traumatic recollections are avoided, then they remain in implicit
memory, and are in a position to be activated should the right stimulus
conditions be experienced, and as they are implicit memories, they are
not being acted on or narrated.
A full model of the response to trauma has to take into account how
the individuals schemata interact with traumatic recollections when
developing the narrative, though even over the long term, the indivi-
duals response can be broadly defined within the two mechanisms of
Learning theory 67
processing and avoidance. The individual either learns to adapt to the

traumatic memories by avoiding them through keeping busy with work,
family, etc., or works on the memories through processing changing
the nature of the memories to stop them being traumatic to integrate
them into his/her belief systems.
Learning theory
Learning theory has been productive for theory, for empirical work and
for treatment of trauma. The basic assumption is that a person develops
fear through classical conditioning, usually taking the form of one-trial
learning known as the Garcia effect,1 which is a basic survival mechan-
ism. If a person behaves in a particular way in a life-threatening situation
and survives, then they automatically remember this for a similar situa-
tion in the future. While this may be adaptive in the traumatic situation,
it may be less so in other situations. The problem, as we shall see, is that
the memory is not just of the survival behaviour in the appropriate
context, but also the emotional, cognitive and behavioural elements,
which constitute traumatic stress. Any reminder of the traumatic event
can automatically activate the fear memory. This works for the condi-
tioning process as well. Orr et al. (2000) showed that people with PTSD
develop conditioned responses to aversive stimuli much more readily
than people without PTSD.
Lang (1979) suggested that emotional images are composed of three
main classes of propositional unit; these are concerned with stimulus
information (e.g. location and physical characteristics of the situation),
response information (verbal, physiological and behavioural responses)
and meaning information (interpretation of the stimulus and response
elements and their significance for the individual; this is tied to narrative
development, as will be discussed in Chapter 8). Lang proposed a
prototype fear image stored in memory. New events are tested against
this prototype. If there is a sufficiently close correspondence, the stored
memory, complete with response elements, is activated and the individ-
ual experiences fear. This programmatic construction explains how the
fear information is only sometimes available to consciousness, in effect
when the individual is provided with a reminder.
The emotional processing of fear and the construction of memories of
traumatic events have been widely studied. Rachman (1980) suggested
1
After Garcia and Koelling (1966), who gave rats food with sufficient poison in it to make
them ill, then when they gave them the same food some months later the rats would not
touch it.
that it is useful to think of people as either successfully or unsuccessfully

processing or absorbing their emotional reactions to stressful events.
Conditioned fear reactions are one of many signs that the emotions
associated with an event have not been processed successfully (other
signs include intrusive thoughts, dreams, behaviour disruptions and the
sudden return of fear). This provides evidence for a common process
underlying PTSD and other anxiety problems such as phobias, which
may have a traumatic origin but may not be treated until much later. The
reappearance of fear after it has diminished in intensity cannot be
explained successfully using traditional conditioning theory.
What separates PTSD from other anxiety disorders is the monu-
mental significance of the traumatic event (Foa et al., 1989). It is so
important that as we have seen it shatters previously held beliefs and
assumptions about the world. Foa et al. proposed a model whereby the
memory for the fear network is held separately to normal memories. The
associations between the elements of the memories are more powerful
than normal memories, and they can be triggered by a number of non-
conscious triggers.
Emotional processing theory is a more sophisticated version of the
above. Foa and her colleagues (Foa and Riggs, 1993; Foa and Rothbaum,
1998) suggested that individuals with more rigid pre-trauma views
would be more vulnerable to PTSD; that is, those with strong views
about themselves as competent and the world as safe would be more at
risk. They also suggested an increased emphasis on negative appraisals
of the responses and behaviours that exacerbate perceptions of incompe-
tence. Those beliefs present around the time of the traumatic event
could reinforce the negative schemata which involve incompetence,
danger or fear that underlie chronic PTSD. Exposure treatment,
providing repeated reliving of the traumatic event, should lead to habitu-
ation of fear, and reinforce more positive aspects, such as safety infor-
mation, eventually leading to the reintegration of dysfunctional and
disjointed memories.
The dual representation of memory

There are two key memory systems with regard to traumatic stress
(Janet, 1925; van der Hart and Horst, 1989; Terr, 1990; van der Kolk
and van der Hart, 1991). These memory systems have been given
various names that essentially refer to the same constructs, such as
verbally accessible memory and situationally accessible memory (Brewin
and Holmes, 2003), or implicit and explicit memory (van der Kolk and
Fisler, 1995). Whichever terminology is used, there is a verbal system
The dual representation of memory 69
that is under conscious control, but is crucially for traumatic stress a

relatively slow processing route. There is also a non-verbal system that is
not under conscious control, and is very fast-acting. We use the verbal
system for our everyday activities, remembering what we had for break-
fast or discussing the latest happenings in the world, whereas we use the
non-verbal system for dealing with automatic processing, such as how to
ride a bike or bowl at cricket. Interestingly, many non-verbal skills are
initially verbal but then become implicit as we become better at them,
i.e. we develop automaticity. The difference for traumatic stress is that
this learning takes place over a single trial the traumatic event.
According to van der Kolk and Fisler (1995), what is remembered
in explicit memory depends on the persons existing schemata. New
to-be-remembered information is incorporated into existing schemata.
Unfortunately, the traumatised individual is unable to incorporate the
new traumatic information into the existing schemata, and hence into
explicit memory. Traumatic recollections enter implicit memory, where
they are not under conscious control. The contents of implicit memory,
at least in the context of trauma, are the individuals initial conditioned
reactions to the trauma, including associated emotional and behavioural
responses. Implicit memory can be accessed via the individual being in
a situation where they are reminded of the stimulus, leading to the
appropriate conditioned response.
In practical terms, the traumatised individual will be able to live a
normal life except when the contents of implicit memory are triggered.
This can mean that the person who successfully avoids all reminders of
the traumatic event can live a symptom-free life. Unfortunately, for some
traumatised people, this activitation is almost constant (Chemtob et al.,
1988). When this happens, the individual experiences traumatic recol-
lections. These are memories of the traumatic event that are still raw.
The individual has not processed them (Creamer, 1995; Creamer et al.,
1992) and has not incorporated them into explicit memory; they have
not developed a narrative.
Memory has two main roles: it is a storage and retrieval system, and it
is a functional system with affective, psychosocial and cultural uses
(Barclay and Smith, 1992). As will be explored in Chapter 8, where
the focus will be on the flexible nature of memory and the role of
individual and social factors in changing memories, cognitive psycholo-
gists and clinicians have explored the malleability of memory. Explicit
memory is an active and constructive process (Bartlett, 1932; van der
Kolk and Fisler, 1995). Inputting new information into explicit memory
depends on existing mental schemata. Once the new information is
integrated, it is no longer available as a separate entity, but only within
the context of the schemata. This has implications for the changes that
may occur in memories over time, depending on individual circum-
stances. Memories can be confabulated, so presumably they can range
along a continuum from being highly accurate to completely inaccurate.
Davis and Lehman (1995) describe what they call counterfactuals
memories of a traumatic event that are not true. This was explored in
detail in the 1990s in the so-called false memory debate, where it was
thought by some that patients were recovering memories of child abuse,
which led to the prosecution of some people, particularly fathers. In the
end, the debate fizzled out, with the general consensus being that these
memories were fictitious and created during the therapeutic process (e.g.
British Psychological Society, 1995). People coping with traumatic
events appeared uninhibited in their ability to generate counterfactuals,
i.e. false memories. The memories of traumatised individuals should be
treated with caution, but not the individuals responses to those memories.
While ordinary memories are not fixed, traumatic recollections often
are. Weine et al. (1995), in a study of Bosnian refugees, quote one
survivor who says that he has films of traumas that constantly play in
his head; although he may look away from them, they continue to inhabit
him (p. 540). This is not an isolated case. Much of the work involving
trauma survivors has indicated that individuals appear to relive the
traumatic event, not just recall it. This reliving is one of the characteris-
tics of PTSD. Koss et al. (1996), in a review of work on traumatic
memories, conclude that there is a consensus of evidence which suggests
that emotion facilitates accurate recall of central details of the event,
though there is no similar increment for the peripheral details. They also
concluded that emotion slows forgetting, and time may actually enhance
such memories, because shortly after the trauma emotions may disrupt
retrieval, but over time such disruption diminishes. Brewer (1992) sug-
gests that the explanation for the durability of emotional memories is not
rehearsal, but occurs at the encoding stage, which would suggest that it
is a form of one-trial learning that is adaptive, in support of the work
outlined above.
Perhaps the most prominent current theory regarding traumatic
memory is Brewins dual-representation theory (Brewin et al., 1996;
Brewin and Holmes, 2003), which proposes that there are two memory
systems known as verbally accessible memory (VAM) and situationally
accessible memory (SAM). The two systems operate in parallel, and
one may take precedence over the other at particular times. VAM
memories of trauma contain information that the person has attended
to before, during and after the traumatic event, and contains sufficient
information to be encoded and stored for later deliberate retrieval. These
Neuropsychological understanding 71
memories only contain what was consciously attended to. They may also
contain the elaborated memories of the narrative, the elements which
did not actually exist during the traumatic situation but which the person
has added to the information, consciously or non-consciously.
In contrast with the VAM system, flashbacks and other trauma mem-
ories are contained within the SAM system, demonstrating that flash-
backs are triggered involuntarily by external or internal reminders. The
information is usually lower level, with more perceptual information
from the scene of the trauma, i.e. information that has received no, or
minimal, processing. The SAM system has no verbal code, and so the
memories are difficult to access and communicate to other people. The
memories do not interact with other memories and so are not processed.
This is an important point, which explains why trauma memories
are fragmented and uncontrolled, and why, in order to develop the
narrative, a person must find ways of accessing the VAM.
The implications of the dual-representation approach are that PTSD
is a hybrid disorder that has potentially two pathological processes. The
first involves dealing with negative and shattered beliefs and assumptions
and their accompanying emotions, and the second involves managing
classically conditioned flashbacks or other intrusive thoughts (Brewin
and Holmes, 2003). Full recovery depends on both being resolved, and
perhaps shows why cognitive behaviour therapy is effective (at least for a
proportion of traumatised people), as it deals with both elements. To
resolve the VAM problems, the person needs to reappraise the infor-
mation, and reintegrate it into their schemata. To resolve SAM-related
problems will require exposure therapy.
In the end, the VAM/SAM model provides integration between cog-
nitive understanding and learning theory. Both are critical to developing
a full account of what happens when someone is traumatised. Now we
have an effective psychological understanding, it is important to under-
pin this with a neuropsychological understanding of trauma processes.
Neuropsychological understanding
Until fairly recently, comparatively little research had been carried
out on the biological underpinnings of PTSD and war trauma. This
is interesting given that the early theories of war trauma implicated
physiological systems, either the heart (soldiers heart during the US
Civil War) or microscopic brain damage (shellshock during the First
World War). The problem with developing neuropsychological under-
standing was that the appropriate methodological tools had not been
developed. It is only with the introduction of imaging techniques that
our knowledge about the brain mechanisms underlying trauma has

rapidly developed.
There is a range of systems involved in the traumatic response,
ranging from the limbic system to the cerebral cortex. Specifically, a
number of areas have been identified, including the thalamus, which
plays a role in sensory input, the hippocampus, which is involved in
memory processing and perhaps the fear response, and the amygdala,
which is involved in the conditioned fear response. Areas that focus on
visuospatial processing and the assessment of threat include the poster-
ior cingulate, and the parietal and motor cortex. Finally, the medial
frontal cortex is involved in a number of cortical responses (Nemeroff
et al., 2008).
The biological effects of fear and stress in laboratory animals (e.g.
LeDoux et al., 1995) initially formed a key basis for our understanding
of the neural pathways involved in PTSD, and this is now being
supported by human studies, though, as we shall see, the findings are
not consistent.
A primary focus of research with humans has been on the hippocam-
pus a limbic structure concerned with memory. The hippocampus
plays a critical role in the development of explicit memories of trauma
(Squire, 1992; Bremner et al., 1995; van der Kolk and Fisler, 1995), and
stress does affect this area, with high levels of glucocorticoids released
during stressful events. Vietnam veterans show an 8% decrease in
hippocampal volume compared with controls (Bremner et al., 1995).
Animal studies have also supported the relationship between stress,
glucocorticoids and hippocampal atrophy (McEwen and Magarinos,
1997). Several studies have since reported reduced hippocampal volume
in people with PTSD (for a review, see Bremner, 1998; Pitman, 2001;
Nutt and Malazia, 2004; Bremner, 2005). The problem is that the
evidence is inconsistent, because other studies find no hippocampal
atrophy (Bonne et al., 2001; Notestine et al., 2002; Stam, 2007), though
it may be that decreased hippocampal volume may be linked to chronic
rather than acute PTSD, or that reduced hippocampal volume is instead
a predictor of PTSD, with individuals with smaller hippocampi being
more likely to get PTSD after a traumatic event. The link to the hippo-
campus does appear to be important, with further evidence coming from
people treated with antidepressants, who show an increase in hippo-
campal volume linked to symptom reduction (Vermetten et al., 2003).
Fear conditioning is mediated by subcortical mechanisms, involving
sensory pathways that project to the thalamus and the amygdala. People
with PTSD have increased activity of the amygdala to fearful or emo-
tional stimuli (Bremner et al., 2005; Williams et al., 2005). According to
Neuropsychological understanding 73
Stam (2007) the altered responsivity of the amygdala seems to support

the idea that reduced inhibitory control by frontal cortical regions over
the amygdala may underlie some of the behavioural hyperresponsivity in
people with PTSD. There is little consistent evidence relating to later-
ality of function in the amygdala in people with PTSD (Stam, 2007).
Animal research shows that emotional memories established via
pathways linking the amygdala and the thalamus may be relatively
indelible (DeDous et al., 1989). LeDoux (1995) studied fear condition-
ing by pairing a foot shock with a sound; this elicited the physiological
components of the fear reaction, such as freezing and elevated blood
pressure. The animal becomes conditioned to respond to the sound
alone after several pairings. The shock alters neurons in both cortical
and subcortical regions of the brain, the central nucleus of the amygdala,
the thalamus, and parts of the cerebral cortex (LeDoux, 1995). The
thaelamic pathway may be the most useful for an immediate reaction,
enabling a response before the organism fully realises what is happening.
Christianson (1992) suggests that this pre-attentive pathway is fast,
independent of context, independent of processing resources and able
to carry out parallel processing of different inputs. It is this pathway
where much of what we remember and forget (including presumably
traumatic memories) is determined automatically. This clearly has
adaptive value, as discussed earlier. Bremner et al. (1995a) suggest that
memory is a survival mechanism during trauma; an organism will need
efficient retrieval of memories in similar future situations.
Propranolol (an alpha-adrenergic antagonist) interferes with the recall
of an emotionally arousing story, which suggests that activation of alpha-
adrenergic receptors in the brain enhances the encoding of emotion-
arousing memories. PTSD patients have more problems with ordinary
stressful events than non-PTSD individuals. Acute stress increases the
release of noradrenaline in the hippocampus, which becomes sensitised
to subsequent stressors, so leading to an accentuation of noradrenaline
release with an ordinary stressor. Southwick et al. (1999) showed that,
under normal stressful conditions, the release of noradrenaline increases
alertness and selective attention to significant cues, facilitating memory
encoding of the stimuli, again having an adaptive function in preparing
the organism for future stressful events.
The prefrontal cortex also plays an important role in the stress
response. This area acts as an interface between internal and external
experience, and is suited to the integration of sensory information
during a stressful event (Bremner et al., 1995). This area also plays
an important role in sustained attention. This links with the work of
Christianson (1992), who focuses on the attentional elements of the
traumatic situation, suggesting that, when individuals feel threatened,

they experience a narrowing of consciousness, they focus on central
details, and it is terror that prevents the integration of traumatic mem-
ories with ordinary memories. Many years ago, Janet (1925) suggested
that, after trauma, memories become unconscious fixed ideas until they
have been translated into a narrative; in other words, they are contained
in implicit memory until they are processed and incorporated into
explicit memory. There may be implications for the amnesia experienced
by traumatised individuals. Individuals may not be able to recall all
aspects of the traumatic event because the event itself may interfere with
general attentional skills or the focusing of attention on details (Wolfe,
1995). With increased arousal the output of noradrenaline leads to
increased activation of the posterior attentional system (Posner, 1993).
In this way we can see how an understanding of the underlying
neurobiology of PTSD and traumatic memories reinforces current
cognitive and behavioural theories.
Other biological associations

PTSD is also linked with a number of other health-related problems,
and there may be longer term consequences, not only for psychological
symptoms, but also for physical illness. Traumatised people often report
problems with physical health. This is sometimes confounded by the
traumatic experience itself. POWs report longer term gastro-intestinal
problems, but these are often associated with the physical conditions of
their imprisonment (Eberly and Engdahl, 1991; Hunt, unpublished
data), though it is difficult to be certain of this, as the studies do not
of course have appropriate control groups. Nevertheless, many studies
indicate the presence of physical health problems in people with PTSD.
The extent to which there is an underlying third mechanism which
causes both PTSD and these physical health problems is unknown,
but there may be linkages with personality traits such as hypochondria
and neuroticism.
There is good evidence of the linkage between PTSD and the cardio-
vascular system. There is a small but significant increase in basal heart
rate and blood pressure in PTSD patients compared with controls,
though there is an overlap between the groups, and the effect is stronger
for chronic PTSD (Buckley and Kaloupek, 2001). There are a number
of potentially confounding variables, such as smoking and drinking
behaviour, which may themselves cause the increase in cardiovascular
problems rather than the PTSD itself. If people with PTSD are exposed
to combat sounds, then they have greater heart rate and blood pressure
Physiology and narrative processing 75
responses than controls (Stam, 2007). This can be a reliable diagnostic

tool for the indication of PTSD. Finally, WWII veterans with PTSD had
higher levels of angina and vital exhaustion than controls (Falger et al.,
1992), but again this may be the result of confounding variables.
While our understanding of the biology and neurobiology of traumatic
memories and PTSD is increasing, there is immense variability in the
findings because of the complexity of symptoms and the complexity of
the individual response. There are also methodological problems owing
to the relative newness of imaging and other methods, but the overall
picture is promising.
Physiology and narrative processing

One area where there is relatively limited understanding of the biological
substrate is that of narrative understanding. Current neuropsychological
research has only had a very limited focus on this area, partly because it
is difficult to break down the various linguistic components of narrative,
but without an understanding we cannot have a full picture of how
people deal with traumatic events. There are a number of brain regions
that are associated with narrative, but the details are largely conjecture.
Most language-based imaging studies are concerned with individual
word processing rather than more complex linguistic structures. As Marr
(2004) states, attempting to ascribe brain areas to the full range of
cognitive activities associated with narrative is a daunting task, though
it is possible to start by exploring those regions we know to be associated
with lower level language tasks. Marr attempts to draw the literature
together using three narrative components: memory encoding and
retrieval, integration, and elaboration or simulation. As narrative is a
high-level task, it is likely that the control of narrative processes is via the
frontal lobe. Specifically, areas of the dorsolateral prefrontal cortex have
been associated with language processing (Fuster et al., 2000). Working
memory is also going to be important for narrative processing (Baddeley
and Wilson, 2002). The episodic buffer of working memory is thought to
be associated with the right frontal lobe.
There are a limited number of neuro-imaging studies of narrative
processing. The major methodological difficulty is the temporal nature
of stories. Some studies have explored story comprehension. Fletcher
et al. (1995), using PET, had participants read stories of varying com-
plexity and found differential activity in frontal lobe areas. Maguire et al.
(1999) also found frontal lobe activation linked to the complexity of
story comprehension, though these studies are not explicitly examining
full narrative processes. Studies of brain-damaged people suggest that
a number of areas are important for story comprehension, particularly

the frontal lobes (Novoa and Ardila, 1987; Hough, 1990) and the right
hemisphere (e.g. Benowitz et al., 1990).
There are very few imaging studies relating to narrative production.
Braun et al. (2001) studied sign language using positron emission tomog-
raphy and, when they eliminated the motor effects of signing, found that
the frontal lobes were important in narrative production, similar to the
findings associated with language comprehension. One of the problems
with this study is that the narrative processes linked to sign language may
differ from those associated with speech production.
Marr (2004) draws the literature together and summarises our under-
standing drawn from the studies described above and others. He con-
cludes that there are a number of key brain areas associated with
narrative. The medial prefrontal cortex is associated with both compre-
hension and production and with ordering; selection processes, in par-
ticular, take place here. This area is also probably associated with theory
of mind, the ability of an individual to recognise the psychological
characteristics of other people. The lateral prefrontal cortex, particularly
the right hemispheric dorsolateral section, is important in the ordering of
events within a narrative. This is also linked with working memory,
particularly episodic memory retrieval. The temporoparietal, posterior
cingulate cortex and the anterior temporal regions are also concerned
with story comprehension and production.
This limited work begins to tell the story of narrative comprehension,
but there is a long way to go to ascertain the specific systems involved
and the role played at different levels of the narrative. The neuroscience
of narrative is a very new area, so it is not surprising that relatively little
is known.
Psychodynamic approaches
Psychodynamic theory has been used throughout the twentieth century
to explain post-traumatic stress, and while such an approach is rarely
accepted in mainstream psychology, at least in Anglo-Saxon psychology,
it is important not to dismiss the contribution made by this perspective,
particularly on the Continent. By exploring psychodynamic theory, we
may find that it enhances our understanding. Emery and Emery (1989)
related psychodynamic theory to the diagnostic criteria of PTSD and
concluded that the distinction between psychoneuroses and traumatic
neuroses should be retained, and that the aetiology of PTSD lies in the
stressor itself. This argument is directly relevant to the debate regarding
the role of the stressor. The critical distinction between explicit and
Existentialism and humanism 77
implicit memory is partly analogous to psychodynamic notions of the

conscious and the unconscious respectively. In Freudian psychology, the
individual has little control over the contents of the unconscious, and
uses defence mechanisms to deal with information contained therein.
While the present approach does not make any claims regarding the
structure of the unconscious, the analogy is acceptable, particularly
as the behavioural effect is for the contents of implicit memory to be
accessed via appropriate stimuli of which the individual may not be
aware.
Freuds seduction theory was one of the first formal theoretical
approaches to describe how traumatic experiences can lead to psycho-
logical problems (see Wilson, 1994). One of the main differences
between this and modern non-psychodynamic approaches concerns
the role of repression and the unconscious. Freud suggested repression
was an ego defence that suppressed traumatic memories. Once these
memories were in the unconscious, neurotic symptoms might arise as a
result of active forces being applied in the unconscious. Modern theory
generally uses the concept of avoidance in place of repression, where the
individual may actively avoid reminding situations. But once the trau-
matic memories are repressed, they do not change, but are retained in an
inactive unconscious (implicit memory) and emerge via the activation of
situational reminding cues. In this sense avoidance is an effective coping
strategy as long as avoidance is effective, while repression requires the
active avoidance of cues, a more difficult task for the traumatised person.
Existentialism and humanism

Individuals who experience trauma can experience growth through the
way they deal with the memories. This is dealt with mainly in Chapter 6,
but needs to be mentioned here in the context of integrating theory.
Herman (1992) focuses on how psychological trauma is about disem-
powerment, loss of control and disconnection from others. She proposes
that recovery is about empowering the survivor and taking on new
connections. To Herman, recovery can only take place in the context
of relationships (e.g. comradeship for veterans), but the only way for an
individual to recover is to do the recovering themselves; there is no
external cure. The survivor has to come to terms with the traumatic past
and reconnect with life. Herman puts this in terms of mourning the old
self and developing a new self. The resolution of the trauma is never
completed; there is no full recovery in the sense of a return to the
previous self. The humanist perspective considers the traumatic experi-
ence from the perspective of the individual in a holistic sense. Many
Vietnam veterans keep alive their memories of the war because they are
significant and meaningful. Many continue to suffer from PTSD
because of this (Bradshaw et al., 1991).
Greening (1990) discusses PTSD in terms of a fundamental assault
on ones right to live, on our sense of worth and on our sense that the
world (including people) basically supports human life. This is similar to
Horowitzs cognitive theory (Horowitz, 1986), whereby our world sche-
mata are shattered by traumatic experiences, and in order to be cured
we have to reconcile these schemata with the evidence provided by the
trauma that the world isnt as pleasant as we believed it to be.
Coping
Coping is critical to understanding how people respond to traumatic
events. There has already been a discussion of some of the different
coping strategies people use, but we can get bogged down when discuss-
ing coping. There are numerous theories, and 40 years of research has
failed to generate any sense of coherence in the literature. Some theories
have just a few coping strategies, others list ten or twenty. This is not the
place to summarise this research, but to outline a simple model that
will inform our understanding of war trauma. It links closely with the
narrative approach taken in this book.
While there are complications, and many theories suggest a range of
coping mechanisms, it is argued here for the sake of simplicity that there
are two fundamental mechanisms for coping with traumatic recolle-
ctions: avoidance and processing. These are the main strategies we use
in everyday life, and the ones we use after a traumatic event. Most people
do most of their coping through avoidance; it is often easier not to think
about a problem and hope it will go away, and in the real world, it often
does. With psychological problems, including PTSD, effective avoid-
ance means that symptoms are rarely or never experienced, but there is
the potential for future problems arising as any trauma-related infor-
mation (e.g. cognitions, emotions) remains in the memory and is not
dealt with. Processing used by most of us for a minority of the time
concerns the active working through of problems, in our case traumatic
recollections. Traumatic memories that are worked through are turned
into narrative-explicit memories. Through the narrative, the individual
deals with the cognitions, emotions and behaviours associated with the
memory.
Both strategies work, but if a person usually employs an avoidant
strategy, traumatic memories may re-emerge many years, even decades,
later. As discussed above, researchers, including Creamer, Horowitz and
Integrating theory 79
McFarlane, have proposed that people resolve their traumatic stress by

moving through cycles of intrusion (processing) and avoidance, dealing
with traumatic information until it becomes emotionally too difficult,
and then moving into a phase of avoidance until they are ready to process
further information. In this way people work through their own
traumatic information over time.
Processing can take many forms, from talking to friends and family,
through writing books and journals, to having formal treatment with
a psychotherapist. All are forms of narrative development and enable
the person to cope more effectively with their memories. This will be
discussed in Chapter 8.
There are important individual differences in coping. Processing
information and developing a narrative requires significant cognitive
resources. There is some evidence that more intelligent people are able
to resolve their traumatic experiences more effectively just because they
have access to these resources.
The single most effective means of helping people to cope with war
trauma is social support. In my own research with war veterans, social
support takes two distinct forms. First, veterans talk to their comrades
about the detailed events of their wartime experiences, sharing the
trauma with people who understand because they were there. Second,
veterans use their families as social support in a different way, not talking
to them about their traumatic experiences, but protecting them from the
emotions associated with them, and relying on the home as a safe haven
from the memories of war (Hunt and Robbins, 2001b).
Integrating theory
It should be clear from the above brief discussion that the different
perspectives in psychology can all contribute to our understanding of
traumatic memory and PTSD. While the core of the book is concerned
with narrative and we will move on to that area in detail in the next
chapter it is critical to acknowledge that an understanding of trauma
from any perspective including narrative must involve integrating
findings from other areas if we are to develop a coherent understanding
of traumatic stress.
It is unfortunate that, in many areas of psychology, researchers focus
on a particular theoretical perspective. The ease with which trauma can
be explained in terms of several perspectives says a great deal about
how trauma theory taps into the fundamental attributes of human
functioning, memory, coping, emotions, beliefs, implicit and explicit
functioning, and our response to stress, and how these are grounded in
fundamental biological structures and mechanisms from which common

behavioural responses emerge. In later chapters, the interdisciplinary
perspective comes to the fore, and we can see how drawing on
the expertise and knowledge of different disciplines can enhance this
understanding of war trauma still further.
6 Positive outcomes of traumatic
experiences
Our greatest glory is not in never falling, but in rising every time we fall
Confucius
That which does not kill us can only make us stronger

Nietzsche
The focus of most research on traumatic stress has, as we have seen in

earlier chapters, been on the negative psychological and social conse-
quences of the event or events how many people experience PTSD,
depression or problems with relationships or alcohol, and how many
people take years to recover, if they ever do. The focus on the negative is
a criticism that is true of much applied psychology, which has usually
focused on what is wrong with people and tried to find ways of putting it
right. While this is admirable, it is not everything.
Most people who go through traumatic or stressful situations are not
traumatised. They come out unscathed, somewhat changed but easily
able to cope, or having learned something about life. There should be a
focus on more positive aspects of change that occur as a result of being
exposed to massively traumatising stimuli, change which may take place
immediately but which is more likely to take much longer, perhaps years.
This positive focus can teach us a lot about the normal psychological
processes that come into play during traumatic situations, but may also
aid clinicians and others to assist people with problems. The experience
of trauma can help people to develop their understanding of themselves,
other people and the world. These ideas link to the existential ideas
regarding the potential for growth and positive change.
Terminology
In the relatively few years since research began in this area, a number
of terminological problems have developed. Researchers have used a
number of terms to represent the positive outcomes that occur after
traumatic experiences. Linley and Joseph (2004) list a number of these
81
82 Positive outcomes of traumatic experiences
terms, including post-traumatic growth, stress-related growth, perceived

benefits, thriving, blessings, positive by-products and positive readjust-
ment. Many of these terms relate directly to the difficulty; for example,
stress-related growth implies that a person must have had a psycho-
logical experience of stress in order to achieve growth. Similarly, the
term positive by-products suggests that a positive outcome is simply
a by-product of the distress, and not really something significantly
positive. Blessings suggest religion, and though religion can play a
key part in positive outcomes, as we shall see, the picture is broader than
that. Thriving suggests that not only has the person achieved a positive
outcome, but that they are rapidly moving forward. Positive outcomes
may not be that positive for everyone! Here we will use the term post-
traumatic growth as it recognises that there was a traumatic incident,
does not require that the person experienced pathology, and recognises
that there is some growth after the event.
For many people, the eventual outcome of a traumatic experience is
significant positive psychological growth, though it may take years for
the person to achieve this. While this approach is relatively new in
psychology, it has a distinguished background in literature and philoso-
phy, where the term suffering is often substituted for trauma, e.g.
Sartres existential position that we interpret our experiences, and that
interpreting them positively in terms of growth will enable us to improve
our lives and our relationships in our own individual ways. An illustra-
tion of this is Sartres Age of Reason trilogy, where the events of Ms life
were described in extraordinary detail, along with his interpretations of
those experiences. Those of us interested in war should read the final
part of the trilogy where it is 1940, and M, now in the French army, is
trapped on a church tower and the Germans are approaching.
Stories of growth go back a long way. Buddhism began because
Siddhartha Gautama (Buddha) realised that people need to come to
terms with the suffering in the world. He set out on a journey lasting
many years to understand the origins of suffering, why people suffer, and
what can be done about it. Other religions also focus on suffering, and
the ways in which we can learn from difficulties. Christianity is another
case, where Jesus died on the cross to relieve suffering though this is
rather a crude example that fails to show the thought processes behind
tragedy and salvation. Similarly, tragedy as art has been used throughout
literate times as a means of demonstrating how we can learn through
suffering, be it the Greek tragedies, Shakespeare or more modern works.
There are examples dotted throughout psychology in the twentieth
century that present evidence for growth. For example, the motivational
theory of Maslow (1954) proposed that we have a hierarchy of needs,
Terminology 83
and that needs at one level need to be satisfied before moving up to the
next level. At the bottom of this hierarchy there are needs for shelter and
food, and at the top there are special moments in life called peak experi-
ences, where, in words not used by Maslow, we experience positive
growth. There are many cases from the horrors of the twentieth century
that demonstrate growth, particularly from the Holocaust. Viktor Frankl
(1963/1984), a Holocaust survivor who wrote extensively about his
experiences and, in his terms, became a better person and a better
psychologist because of his experiences, discussed growth and the way
he managed to interpret his experiences over the following years and
decades and use these interpretations to help others.
What do we mean by growth? Is it simply a change after a traumatic
event that, in some cases, leads to a perceived better understanding
of the world in some way, or do people actually become happier or
more satisfied with life? Learning something about the world does not
necessarily make someone happier, so growth is not about happiness.
Fundamentally, the concern is with a changed perception regarding the
self a better understanding of self, others or the world. Growth implies
change towards a different (and assumed better) structure of the person-
ality and identity. The person who experiences growth after a traumatic
event will look at the world differently, perhaps in a less nave manner,
recognising for instance that the world is more complex than they
thought or less good, or that by seeing the vulnerability of people there
is a recognition of the importance of living ones life to the full, of not
wasting time on trivial activities, or gaining a positive outlook even when
carrying out the most trivial tasks. Many people look on others in a
different way, recognising them as people with rights and responsibilities.
There is no one area where people experience growth, but these are
some of the key aspects. The traumatic event makes a person re-evaluate
his or her life; that person tends to reflect on the traumatic event how
they and others behaved, thought and felt, and the implications of these.
Through this, fundamental change relating to the self can occur. This
may entail a changed philosophy of life, with the realisation perhaps
that the acquisition of ever-more wealth is unimportant compared with
having a good relationship with ones family and friends. The change of
perspective is fundamental. The person may realise that the sound of
birds in the morning, the rustle of the wind in the leaves, or the varying
nature of the earth around us, is much more important than social status
and wealth. This change occurs specifically because of the threat to life
that has been experienced.
Much of this may seem to be stating the obvious, but in reality many
of us living ordinary lives have a philosophy of life that is not thought
through particularly well, at least not until the person is challenged in

a fundamental manner, as with a life-changing experience such as a
traumatic event.
Why is it that after a traumatic experience some people are trauma-
tised, some people experience growth and some people appear to change
very little? There is a range of personality factors that impact on out-
come: factors relating to resilience, coping styles, perceived social sup-
port, cognitive abilities, etc. Which of these are important in
experiencing growth? According to Lev-Wiesel and Amir (2001), who
have studied survivors of the Holocaust, these differences result from the
level of a survivors personal resources in terms of sense of potency, self-
identity and social support.
In my study of Second World War veterans (Hunt, 1996), veterans did
see positive sides to their war experiences. Many experienced foreign
travel for the first time, they got to use the latest technology, and,
perhaps most importantly, they got to meet and mix with people from
other social classes, people they would usually not get a chance to meet.
For many, this was the most important positive aspect of their war
experience and, it can be argued, it was the area to have most impact
after the war, contributing to significant changes in the social class
structure. Furthermore, people fought the Second World War for posi-
tive reasons: to remove Hitler and the evils of Naziism, to free the people
of Europe, to protect their families and to create a better society. These
factors are important in contributing to a change in outlook, and also
contributed to the unexpected Labour election victory in July 1945.
In these terms, we can see a socially constructed notion of positive
growth after the war, at least at the societal level, if not always at an
individual one.
Assessing growth
There are a number of ways to assess post-traumatic growth, both
qualitative and quantitative. Most research has focused on questionnaire
measures, designed to assess particular aspects of growth, though quali-
tative approaches are also used.
There are a number of quantitative measures available, and while this
is not the place to review them, it is worth mentioning two that have been
used widely and to good effect. The Post-traumatic Growth Inventory
(PTGI) was devised by Tedeschi and Calhoun (1996) as a 21-item self-
report inventory that measures the persons perception of positive
change resulting from a traumatic life experience. People are asked to
use a 06 rating scale to measure the extent to which their views have
Evidence for growth 85
changed across a range of areas, for instance A feeling of self-reliance or

Appreciating each day. The PTGI was validated using students,
though it has been widely used on more appropriate populations.
The Stress-Related Growth Scale (Park et al., 1996) is a longer scale
(50 items), which again asks about change, this time in the specific areas
of personal resources, social relationships, life philosophy and coping
skills. The measure has a three-point (02) response choice. A typical
item is You learned to be a more confident person. Again, it was
developed using students, though it was specifically adapted to stressful
situations. Statistical analyses indicate that it is a single scale, and should
be used as such, rather than broken down into subscales.
These two scales are just examples. Others are available, but these
provide you with a reasonable idea of how positive growth is measured
using self-report scales. There are, of course, numerous problems with
such scales, from reporting bias to the relatively shallow information that
can be obtained from such a measure. The main alternative is to use
open-ended questions or interviews. The latter are more effective
because they enable a greater depth of information to be obtained. This
is important in this area because positive growth differs significantly
across people, and we need to understand exactly what changes are
taking place.
While these quantitative measures are well validated, there is a serious
problem, in that the notion of growth is closely associated with meaning
and meaning development. A prescribed questionnaire restricts the
range and depth of responses that a person can give, and so may give
a misleading idea about whether they have experienced growth.
A qualitative approach, on the other hand, can enable a free discussion
of the variety of areas that may be considered to have growth potential,
and hence that may provide a more accurate picture of the extent and
type of growth experienced. The problem with a qualitative approach is
that it does not provide a measurable variable with which to determine
the relationship between growth and other factors, so depending on the
circumstances, it may be more appropriate to use a quantitative mea-
sure. The close relationship between growth and narrative development
shall be explored later in the book.
Evidence for growth

Rosner and Powell (2006) used a Bosnian version of the PGTI to explore
growth after the Bosnian war. The original wording of the measure,
relating to changes that have occurred as a result of your crisis, was
inappropriate because of the complexity of the war experiences, so they
changed it to in comparison with the period before the war. The

authors found a positive relationship between coping styles and positive
growth, and concluded that post-traumatic or adversarial growth is
something more than another coping mechanism, though the finding
suggests that growth is closely associated with a particular coping style.
It is difficult to conclude that the authors were measuring genuine
change and growth resulting from war experiences, both because of the
problems associated with the quantitative nature of the PGTI and also
because of the nature of war. It is difficult to see how any measure that
breaks down such a complex construct as psychological growth occur-
ring as a result of traumatic experiences to a series of simplified tickbox
response categories can be accurate. The construct of growth has many
facets and may need to be assessed using more complex and appropriate
qualitative methods. The issue of war is also complex. Using a phrase
like in comparison with the period before the war is problematic. War is
complicated. The participants will have had many experiences both
during wartime and afterwards that will have impacted on their outlook
on life. As many of the participants were young, maturity alone will have
changed the way they think irrespective of the war. Also, during the
war they will have had many experiences that had nothing to do with war
and that will have changed them. Rosner and Powell (2006) conclude
that post-traumatic growth is associated with increased value given to
relationships with others in other words, a more effective use of social
support. The study does not because of the use of the measure it
cannot conclude anything more complex than that. We are left unclear
as to whether these participants have genuinely experienced post-
traumatic growth as a result of their traumatic war experiences, or
whether they have simply matured in certain ways between the time
before the war and the time they were tested. In fairness to the authors,
they do conclude that the number of measures available hampers the
research into post-traumatic growth, and that there is little conceptual
overlap between the measures, making it difficult to compare studies.
They also concluded that their study showed limited empirical evidence
for growth due to war, and that there is no evidence that any growth that
does occur is a result of specific traumatic events.
Research has been conducted that specifically examines the role of
post-traumatic growth and war, though it is relatively limited. Elder and
Clipp (1989), using a sample of 149 US veterans of World War Two
(Korea and Vietnam), referred to growth through coping with adversity,
discipline and learning to value life more; this was particularly the case
for those who had experienced higher levels of combat. Fontana and
Rosenheck (1998), interestingly, had only a single open question on
Growth and psychotherapy 87
growth, and showed a relationship between growth and perceived harm

and threat along with a relationship between education and growth,
which may be an indicator of the relationship between cognitive func-
tioning and growth. Maercker et al. (1999) were interested in both the
positive and negative effects of the Dresden bombing in 1945, and found
salutogenic factors resulting from the bombing.
Research on child Holocaust survivors has focused on two areas:
firstly showing that Holocaust child survivors have great difficulty main-
taining cohesive and independent self-identities, and secondly, that the
resilience of many Holocaust child survivors has enabled them to
develop successful careers and have good stable marriages and caring
families (Lev-Wiesel and Amir, 2001). Sigal (1998) showed that there is
a strong sense of resilience among survivors of the Holocaust. Similarly,
Moskovitz (1983) interviewed 23 child survivors and found that they
had a positive outlook on life, a strength (durability) of character, and a
desire to have a stable family life and be committed to the social world.
Lev-Wiesel and Amir (2006) studied 97 Holocaust child survivors and
used a range of measures to assess PTSD and post-traumatic growth.
They found that the higher the level of the survivors personal resources,
the less they suffered from PTSD symptoms. There was also a positive
association between social support and post-traumatic growth. (See
Calhoun and Tedeschi (2006) for a good edited account of research into
growth.)
Growth and psychotherapy

The concept of growth under a number of different names has been
around within psychotherapy for many years. Carl Rogers (1980)
founded the school of client-centred psychotherapy in opposition to
the traditional schools of behaviour therapy and psychoanalysis. Rogers
was influenced by existentialism and by humanism, and focuses on
people being basically good and thoughtful, rational people. Building
on work such as that of Maslow with his hierarchy of needs, Rogers
assumed that there is a constructive force the actualising tendency
which is within everyone and helps them to develop to become better
people. According to Rogers, there is an innate ability or force that drives
us to improve ourselves, to become better when ill. If this theory is
correct, then the normal outcome after a traumatic event should be
positive growth. Of course, others factors play an important part, par-
ticularly a nurturing environment. Without this, the person will not be
able to fully use the actualising tendency. Psychotherapy is about helping
individuals who, for some reason, are unable to draw on the actualising
tendency. Rogers does not explicitly discuss the kind of post-traumatic

growth considered in this chapter, but he does make a theoretical con-
tribution to our understanding of why some people experience growth.
Victor Frankl, mentioned earlier, drew on his Holocaust experiences
to develop his own psychotherapeutic approach. His approach, known as
logotherapy, is based on a spiritually orientated approach to psycho-
therapy. According to Frankl, finding meaning as a source of strength
was critical, as was finding the potential for growth amidst adversity. He
used the term will to meaning, which, Frankl suggests, is present in
everyone. It has a similar formulation to the Freudian notion of the
pleasure principle (the will to pleasure) but is more important. There
is a fundamental striving in people to find meaning and purpose in life
(Frankl, 1969). According to this approach, there is the existence of a
spiritual component in everyone. In a similar fashion to Maslow and to
Rogers, this inner force enables people to transcend negative situations.
Therapy is concerned with helping people with their quest for meaning.
Frankl distinguished between present meaning, relating to particular
situations in which the person finds himself, and supermeaning, which
relates to the meaning of life for the individual. Therapy focuses on the
first of these, helping the person to find meaning relating to specific
situations. The person will then be in a better position to find and
develop his or her meaning of life.
Existential approaches are also concerned with the development of
meaning, but focus more on the more fundamental existential questions,
such as meaninglessness, death and freedom (Yalom, 1983). Yalom
discusses the role of meaning-making that is important when a person
is dealing with tragic or difficult events.
Spirituality
One area that is often neglected by psychotherapists and psychologists in
general is the role of spirituality. The mainstream monotheistic religions,
Christianity, Islam and Judaism, are rarely about personal growth
and more about appropriate behaviours for a better future in heaven.
Spirituality, on the other hand, while it is closely linked with belief in
god, is also concerned with growth and the development of meaning in
ones life. Spirituality is important for many people. It is notoriously
difficult to measure, as it is a complex construct. Spiritual issues often
come to the surface when people face serious crises. The link with post-
traumatic growth can be seen in the work of Tedeschi et al. (1998), who
include a new sense of spirituality or religion in their conception of post-
traumatic growth. This is quite rare; notions of spirituality (and religion)
Narrative growth 89
are largely absent from, or peripheral to, most theories of psychology

let alone theories of personal growth. This is a serious omission, and it is
interesting to speculate why it is so. While it is easy to ask someone if
they are religious, whether they believe in some form of god, it is more
difficult to determine spirituality. While some psychologists take religion
into account it is quantifiable in the sense that someone can report they
are religious or not, or that they belong to a particular religion, it is very
difficult to determine what people mean by god, or by spirituality which
are not the same thing. People will say they believe in god without
necessarily having a clear idea about what god is. As soon as the word
spirituality is discussed, it becomes more difficult.
Spirituality is, in essence, more difficult to explain than religion. The
words origins relate to the wind, and the meaning does seem to get lost
on the wind in that it means different things to different people. For
most, spirituality and religion go closely together, but there are spiritual
people who do not believe in god, and religious people who are not
spiritual. Most psychologists either fail to account for the distinction
between religion and spirituality, or assume that spirituality can be
accounted for by inner strength, improved relationships with people
or having a clear meaning as to the purpose of life. While spirituality is
concerned with these, it is also something more. As this is not the place
to begin a religious and philosophical debate as to the meaning of words,
we should focus on the role of religion and spirituality in post-traumatic
growth. Many traumatised people will say that their god or their spiritual
self plays an important role in dealing with traumatic events and in
experiencing post-traumatic growth; this may take the form of feeling
closer to god, or understanding the meaning of their gods world.
Essentially, religion plays an important supportive and explanatory role
(see also Dale and Hunt, 2008). People rely on religion for explanations
of what has happened to them, and they rely on their god to help them
through their problems.
Narrative growth
Narrative is a useful concept that can help us to explain growth. As we
have seen in earlier chapters, if a person is going to resolve traumatic
problems that have arisen because of the fundamental rift that occurs as
a result of a traumatic event, then they need, if they are not going to
use an effective avoidant strategy, to develop a narrative of the event.
The strong argument here is that the development of an effective narra-
tive more or less guarantees that the person will experience growth. The
focus is on the word effective. Many narratives are not effective, and do
not enable someone to move on. A narrative may lack coherence, and
in so doing may be ineffective at helping the person come to terms with
their experiences.
As noted, one of the problems with the literature on psychological
growth is that it takes a relatively narrow focus, and attempts to quantify
growth through questionnaires, when growth is, by nature, qualitative
and personally meaningful. To measure growth is to ignore the key
meaningful elements of growth.
Neimeyer and his colleagues (Neimeyer, 2005, 2006a, b; Neimeyer
and Levitt, 2001) have discussed the notion of post-traumatic growth
through narration. Post-traumatic growth is seen as a form of meaning
reconstruction in the wake of crisis and loss (Neimeyer and Levitt, 2001).
Neimeyer does believe that a narrative approach to understanding growth
is little utilised, but is capable of being among the richest literatures in
the field of growth. This is, in part, because of our natural penchant
for both telling stories and for being an audience, as already discussed.
This kind of evidence should link the literature on social support and
on narrative as all stories need a listener but there is little evidence for
this link. Few authors have explicitly discussed how it is that social
support is usually the best predictor of recovery from a traumatic event
and the role of narrative in such recovery. This highlights a problem
with the social support literature. Much of it is based on crude measures
of support, whereas its effects may be best identified through the study of
narrative. If this link was made explicit, then we are likely to provide a
much better explanation for the role of social support. This notion is
hinted at by Neimeyer (2006b) when he discusses how considering
narrative at social levels can establish the context for post-traumatic
stress or for growth not only at the level of the individual but also at
the level of society as a whole.
Neimeyer (2006a) discusses several forms of narrative disruption,
including disorganised narratives, where the individual is immersed in
the perceptual elements of the traumatic experience and is unable to
draw them together (this is the area most closely associated with work on
post-traumatic growth), dissociated narratives, which are silent stories,
those in which the person is unable to relate in the social situation, such
as the suicide of a spouse, and finally dominant narratives, which are, in a
sense, too cohesive in providing an explanation for the traumatic event.
A healthy profile of a person post trauma is one in which such narrative
disruptions either do not take place, or they take place temporarily, only
to be displaced by a new, more effective and growthful narrative.
According to Neimeyer (2006b), healthy profiles of post-loss adaptation
concur with the view that resilient survivors are able to assimilate their
Narrative growth 91
loss into their existing narratives in a way that does not radically alter or
undermine the way they look at life, the key themes of their life story.
Neimeyer (2005), in a discussion on bereavement, argued that accom-
modation is also important, with bereaved individuals struggling to
accommodate their self-narratives to integrate their loss, and also
accommodating their lives to the changes necessary to adapt to the loss.
According to Neimeyer, this interpretation of assimilation and adapta-
tion may help as a heuristic by which we can understand the multiple
pathways people negotiate bereavement.
There are a number of methods by which people have studied narra-
tive and growth, e.g. repertory grid (Fransella et al., 2004), where
biographical grids are constructed to help the person articulate their
key life themes, systematically comparing critical life events. These
critical life events are not just related to the trauma; they are other key
aspects of life. For instance, if a person has a theme of helplessness/
control, then by applying this to different events, e.g. getting married or
being at work, and to the traumatic event, the person can work out the
relationships between the key themes and these events, and see which
events are linked, and how they are linked across themes. This may be of
benefit in helping a traumatised person to make sense of how that
persons traumatic events fit within his/her larger life story. Another
approach, widely used in different forms, both in research and clinically,
is to encourage the person to reflect on the key events within his/her life,
and then to build a narrative picture of that persons life from this. Each
key event is a narrative or a chapter of the life story in itself, and the
individual is encouraged to link these together to establish important life
themes and to enable the key events surrounding the trauma to be
incorporated. A further approach, which has varying levels of support,
is that of Pennebaker (1997), which involves the individual writing about
their experiences for 20 minutes a day for 3 days. According to Pennebaker,
this procedure is effective in reducing symptoms, and contributes towards
the development of a meaningful narrative. The evidence for this is
mixed, and different forms of the paradigm have been employed.
Clinicians and researchers regularly encourage traumatised or
bereaved people to develop narratives about their experiences, to help
them make sense of, and hopefully learn from, their experiences.
Guidano (1995) has proposed a method whereby emotionally discrepant
episodes in a persons life are replayed in a slow motion fashion, focusing
on the difficult, emotional and painful details, and then panning out to
consider the impact of these episodes on the persons broader life. The
idea is that this method will help the client to make sense of his/her
experiences, to close the gap between experience and explanation.
Resilience
According to Meichenbaum (2006), self- and group-narratives play a
critical role in determining whether individuals and groups display
persistent distress and PTSD or whether they will evidence resilience
and post-traumatic growth. Meichenbaum takes a constructive narrative
perspective of the concepts of resilience and post-traumatic growth. This
perspective has five key points:
(1) People are storytellers.
(2) The type of story used by individuals and groups following a
traumatic event determines the level of distress versus resilience.
(3) Research indicates the specific features of negative behaviour and
thinking that lead to PTSD.
(4) Healing activities work because they enable individuals and groups
to engage in non-negative thinking.
(5) To move from resilience to post-traumatic growth, individuals
and groups must find benefits, establish a future orientation and
construct meaning.
This kind of model is helpful in demonstrating the processes that occur
in people after a traumatic event. The concept of resilience is helpful
because it shows how people can show positive adaptation and not break
when exposed to adversity. Meichenbaum proposes that resilience is not
an inbuilt personality trait, but a skill that can be developed. He draws
on an American Psychological Association Help Centre that suggests
ten ways to build resilience:
(1) Make connections.
(2) Avoid seeing a crisis as an insurmountable problem.
(3) Accept that change is part of living.
(4) Move towards goals, but stay flexible.
(5) Take decisive action.
(6) Look for opportunities for self-discovery.
(7) Nurture a positive view of oneself.
(8) Keep things in perspective and learn from the past.
(9) Maintain a hopeful outlook.
(10) Take care of yourself.
Meichenbaums constructive narrative approach builds on our under-
standing of narrative that people live by storytelling and listening
to others stories and incorporates the notion of resilience, building to
a demonstration of what is meant by growth, which includes benefit
seeking, finding and reminding for self and others, engaging in downward
Issues surrounding post-traumatic growth concepts 93
comparison (it could have been worse), establishing a future orientation

and constructing meaning.
The assumption that, if someone experiences a traumatic event he/she
will have a negative outcome, is often wrong. Bremner (2005) gave a
presentation for a group that included some ex-POWs on the possible
effects of the stress of captivity on heart disease, when an ex-POW
challenged him and asked why there couldnt be positive effects. The
veteran stated that there were positive effects of POW experience,
including the knowledge that one could survive anything that life had
to offer, having an increased tolerance for others resulting from sharing
cramped quarters, and developing skills that were useful for later life.
The example given by Bremner is memory. Several POWs developed
mnemonic skills that were useful for finishing their education. One
person said that he had learned the names of every POW in his block
in the Hanoi Hilton camp in Vietnam. Thirty years later, he could still
remember all the names.
Issues surrounding post-traumatic growth concepts

As is the case for most trauma research, most work relates to the short-
term outcome of traumatic experiences, and how positive change can
occur over a period of a few months, or a year or two at the most.
Positive growth may take many years. What is needed is research that
demonstrates positive change over decades. My research with Second
World War veterans shows that such positive change can occur, but that
brings up another problem that the relationship between the traumatic
experience and later interpretation is complex and irreducible to a
simple comparison between traumatic experience and current psycho-
logical state, so it is difficult to ascertain whether positive changes are a
result of the traumatic experience, learning from the traumatic experi-
ence, or other events that occurred after the traumatic experience.
In reality, of course, it will be a combination of all these things and more.
This leads us to another problem associated with the field that most
of the research focuses on self-report scales, reducing individual varia-
tion to simple numerical values. While such research is valuable, if we
are to understand positive change then we need to take an idiographic
approach, and to explore the experiences of individuals rather than
groups. While nomothetic approaches may recognise that a range of
variables impact on psychological outcome (whether positive or nega-
tive), they cannot reconstruct the complexity as experienced by the
individual.
Linley and Joseph (2004) also recognise the over-reliance on self-report

measures, but in terms of them not allowing for negative responses
(to indicate both a negative outcome as well as growth). They also note
other methodological problems, such as the need for prospective longi-
tudinal designs, the need for collateral assessment of related behavioural
and physiological indicators, and importantly the notion that adver-
sarial growth is simply the adherence to some cultural script that some
people report growth simply because they have been led to believe that
good things come from traumatic events (p. 19). This last point dem-
onstrates that memories are not simply a result of the individual, but also
of the social world. It is not only universal psychological factors we must
take into account, but cultural factors also.
There is some research relevant to the notion of very long-term
growth resulting from traumatic experience, such as that relating to life
review (Butler, 1963), and more recent work concerning reminiscence
(Coleman, 2005). This research does not specifically focus on the out-
come of traumatic experiences, but the theoretical approach is relevant
and there is evidence resulting from war experience. Butler (1963),
building on the life stage model of Erikson (1982), stated that as we
age, we begin to look back on our lives and address any unresolved
issues. This is likely to occur when we start having more time available,
particularly after retirement, or when the children leave home or a
spouse dies. This may be a preparation for death that people have a
drive or urge to sort out unresolved issues before they can die peacefully.
There is anecdotal evidence for this. A clinical psychologist colleague
was treating ageing veterans with war trauma. Out of a group of eleven,
five died within months of the completion of treatment. Is this because
they had resolved their issues concerning their war experiences? Perhaps
or perhaps not. This is not empirical evidence one way or the other, but
the ethical issues arising out of his treatment of such ageing veterans
intrigued my colleague. If resolution did increase the chance of dying
earlier, and if clinical techniques aid such resolution, was he indirectly
killing them? Is this assisted suicide, or is it simply that he helped them
die feeling more contented than they otherwise would have done?
Conclusions
The notion of post-traumatic growth has become very popular over the
last few years, and research in the area shows no sign of abating. There is
evidence that, after a traumatic event, people learn and experience
growth. This is demonstrated in the novels that emerge out of war, or
the non-fictional accounts written by people who have been through
Conclusions 95
terrible events and have somehow learned to live with their memories.
After a burgeoning of psychological work in the 1960s and beyond that
looked at humanistic and existential approaches to psychotherapy there
is, at least within mainstream psychology, a mechanical and reductionist
approach to much of the work on growth. This is seen particularly in the
various questionnaires that are meant to measure growth. They take a
complex concept and break it down into parts that are less than the sum
of the whole. The narrative perspective does enable us to address issues
of meaning-making and story development within the context of growth,
and enables a deeper understanding of exactly what we mean by growth.
Finally, we should note that many people do not experience growth at
all, nor do they experience PTSD. Many, perhaps most, people just carry
on with their lives. The factors that predict how and whether someone
will experience growth are not well understood. Perhaps as psycholo-
gists, as clinicians, as academics generally, we should stand back and
think about what happens to those people who neither experience deep
distress nor narrate their experiences. They carry on with their lives, but
perhaps with an enhanced wisdom that they have learned from their
experiences. I spoke with a war veteran who had been captured at Calais
in May 1940, served down the mines as a prisoner in Silesia, and been on
the forced marches in 1945 away from the advancing Russian lines.
He said that whenever he becomes emotional about the war, he will go
out into his vegetable garden, tend the plants and realise that what is
important about the world is the everyday things growing onions, the
changing seasons and life itself. Did he learn this at least partly through
his traumatic experiences, or did he just know it because he was brought
up and lived his whole life in a village?
7 Memory and history
This chapter and the next form the heart of the thesis in the book. This
chapter focuses on the role history plays in understanding the psycho-
social response to war trauma, while the next chapter focuses on the role
social factors play in psychological understanding, building together to
develop the concept of the personal narrative. The arguments can be
expressed from a variety of cultural perspectives, but due to my own
upbringing and background, the examples that are used to illustrate
what is meant by memory, history, social discourse and narrative are
drawn largely from my own experiences of being brought up English and
European.
The focus here is on the psychological perspective. We are trying to
understand at the level of the individual, but we are all socio-cultural
creatures, so in order to understand the individual effectively we need to
draw on broader social and cultural forces so as to understand how a
person interprets the past and the present, and how that person looks to
the future. If we want to understand psychological processes fully, we
need to be able to separate the universal from the cultural aspects. What
are the key universal psychological processes about memory, coping and
the response to stressful events, and what are the cultural aspects of
these? This is intensely relevant to trauma studies, but is also relevant to
the ways in which all of us live our lives as social beings. There are two
fundamental truths about humans that are relevant here. First, that
without memory we are nothing. If we do not remember the past we
have no structured life. Second, that we are social animals. If we lived in
an isolated world we would not learn; we would not have any sense of
structure in our lives. We would not have life.
Definitions
Definitions are necessary here because there is dispute about the mean-
ing of many of the terms used. This largely arises because they are used
in different ways across disciplines.
96
Definitions 97
History. This is the non-psychological past that is defined and deter-

mined by the systematic research of academic historians. It also refers
to that part of the past (the distant non-rememberable past, i.e. beyond
about three generations) that has no psychological relevance because
there is no-one around who remembers that time or who knew people
who remembered that time. An example might be understanding the
role played by King Henry VIII in the establishment of Protestantism in
England. That is not to say that Henry VIII does not have a current
impact on our lives (note the debate regarding whether a British
monarch should be allowed to marry a Catholic), but that none of us
has a psychological memory of that time.
Collective memory. This refers to the joint memories held by a commu-
nity about the past. It can refer to any period in the past, but in
the current context it has the more specific meaning of the collective
memories held over about three generations. In order to have a collective
memory an individual does not need to have experienced the event, but
it must be of such importance that it is thought of in memory rather than
in historical terms. An example might be someone born after the Second
World War still thinking of it as memory, partly because the people
around them experienced it and behave in ways that demonstrate
their experience, and partly because the evidence of the war is in the
environment.
Social discourse. This is the ways of thinking that are prominent in a
society at a given time. These ways of thinking are brought about
through the media, education and general social interaction. Social
discourses relate to the important areas of interaction between people,
and the beliefs that people hold. They relate to the relationship between
the sexes, attitudes towards foreign countries and peoples, or views
regarding supermarket shopping or the value of television. There are
thousands of social discourses throughout society, some assuming more
potency than others at given times but, as we shall see, they change
dramatically over time. They are not agreed by everyone, but are gener-
ally accepted by most or many people, both explicitly and/or implicitly.
There are, at any one time, conflicting forms of social discourses held by
people within society.
Narrative. The narrative or story is at the heart of what it is to be a
psychosocial human being. We naturally try to make sense of things,
whether that is finding a good reason to go out for a beer or trying to
understand the nature of the universe. Inevitably, owing to our social
nature, our individual narratives are determined not only by how we
think, our own memories of our experiences, but also by others, and by
the social discourses that exist in society. Individuals do not have a single
narrative; the narrative depends on the audience. A father narrating his

day will talk to his small son in a different way to how he talks to his wife.
A teacher will describe her career differently to a prospective headtea-
cher and to her boyfriend. The narrative is at the heart of understanding
behaviour.
The main focus in this chapter will be history and memory, which will
then lead into the discussion of social discourse and narrative in the next
chapter.
The relationship between memory and history

History is perpetually suspicious of memory, and its true mission is to suppress and
destroy it. (Nora, 1989, p. 9)
Memory is now the focus of interest to people across a range of academic
disciplines, far more than it was a few decades ago. It is no longer the
sole remit of psychology. When we discuss collective memory, for
instance, a number of disciplines become important, including soci-
ology, history, political science and anthropology (Wilson, 2005). The
new journal Memory Studies explicitly states that it is a journal that hopes
to draw on a wide range of disciplines, and help academics to develop
and present theories that are interdisciplinary in nature. As Olick
(2008), writing in Memory Studies, put it, we now have sociologists
interested in cognitive psychology, and cognitive psychologists interested
in sociology. This interaction has to be a good thing, broadening our
understanding of memory, outside the normal remit of a narrow aca-
demic discipline. Another journal, Memory and History, though it has an
explicit focus on the Holocaust, is also concerned more with the general
relationship between memory and history.
Memory is derived from the Greek work mnema, from Mnemosyne,
the mother of the Muses. Before the invention of writing and other
recording devices, memory was the poets key skill. History is associated
with logos and with narrative, i.e. a narrative rendition of the past.
History gradually emerged from memory when it became a reevaluation
of the past, particularly in written form narrative and reinterpretable
and later gradually developed into a social science. The narrative nature
of history is seen in Herodotus, the Father of history, who explicitly
reconstructed and stabilised the past to provide a fixed story. According
to Favorini (2003), we can distinguish between history as a chrono-
logical record of significant events affecting a nation or an institution,
and memory (or collective memory) as a set of recollections, repetitions
and recapitulations that are socially, morally or politically useful for
The relationship between memory and history 99
a group or community. This is a useful distinction for psychologists.

Whereas history is generated by an individual, is unequivocal and
depends on systematic evidence, collective memory is generated by the
group, is multivocal and is responsive to the social framework in which it
is created, i.e. the social discourse. Psychologists usually focus on the
individual rather than the collective nature of memory, the processes by
which we as individuals remember and forget, and what we forget (or do
not learn in the first place) is as important as what we remember.
Inevitably, when discussing concepts across disciplines, there are
disputes about the nature and meaning of these terms. Halbwachs
(1992), a French sociologist who worked in the first half of the twentieth
century, eventually becoming part of history by dying in a German
concentration camp in 1945, was interested in the relationship between
collective memory and history, contrasting them as two contradictory
ways of dealing with the past. According to Halbwachs, history begins
where social or collective memory stops operating. He argues that there
is only one objective history, but many collective memories. Collective
memories are confined to the most recent past (the lifetime of the people
in the society) and are valid only for people within that society. History is
the academic objective study of the past, whereas there are collective
memories of the past which are shared by communities and which are
specific to that community, i.e. are subjective. Halbwachs takes the
traditional view of history, as an attempt at developing objective and
impartial accounts of the past. He also saw a distinction of time. History
can consider both the recent and the distant past, whereas memories are
restricted to the recent past, i.e. the lifetime of the individual, and are
limited to individuals who lived through particular events.
Halbwachs makes a further distinction between personal and historical
memory. Personal (or autobiographical) memory is the memory of
things that the person actually experiences, whereas historical memory
is about the world beyond ones own personal experience, and can
include things that happened before you were born. Importantly, to
Halbwachs as a sociologist, historical memory has priority over autobio-
graphical individual memory. Historical memory provides a social
framework for the functioning of individual memory. This creates the
social context for remembering things peculiar to oneself. Individual
memory processes will always depend on social factors that impact on
what we remember and forget. According to Halbwachs (1992), the
individual is dependent on society, so it is only natural that we consider
the group in itself as having the capacity to remember (p. 54). Halbwachs
states the strong argument that, once the social aspect of memory is
removed, there is nothing left that can be called memory.
As already stated, without memory we do not exist. Where there is no

remembered past there is no present, because the present cannot be
interpreted without knowledge of the past. How we read and write, how
to walk, how to talk, knowing people, working, all require memory.
There is neuropsychological evidence showing the difficulties that some
brain-damaged patients can have leading normal lives if they have sig-
nificant memory impairments. People with damaged short-term mem-
ories can no longer remember meetings they have had just a few minutes
earlier, and they are doomed to repeatedly re-enact scenes. They cannot
meet and remember new people, though their memories of earlier times
may be intact. Others lose their long-term memories, and may no longer
be aware that they are married or have children. These cases are each
individually tragic, and wreck the lives of affected families.
It can also be argued that, without history, a society does not exist;
history is intimately linked to the social and cultural world of which we
are all a part and which has made us the people we are. Some authors
argue that memory and history are not that different. Geary (1994)
argued that both collective memory and history are memories for some-
thing, i.e. that any representation of the past has some political meaning,
and that historians are actively trying to influence our past and our
memories of the past. While this is true, the arguments can become
muddled. Apart from the special case of oral history, the assumption
is that historians are trying to develop a systematic understanding of
the past. It differs fundamentally from memory, whether individual or
collective, in that memory is subjective, and not necessarily constrained
by a search for the truth.
In many traditional societies, i.e. those without a literary tradition,
there is no real distinction between history and memory; cultural ideas
are expressed through the oral tradition. Academic distinctions between
memory and history are relatively recent constructions. In traditional
societies, it is the role of specialists (often the epic poets) to remember
detailed accounts of the past and to pass them on to future generations.
Such historical knowledge and its perpetrators are revered in many
societies. Now, it is argued by Nora (1989), as shown in the quotation
at the beginning of this chapter, history is destroying memory. Nora
argues that there are stages of memory collapse, such as the destruction
of peasant culture, which was the repository of collective memory. As
with Halbwachs, real memory is, according to Nora, social, and is
retained in so-called primitive societies, where it is not recorded in
history books, but retained in the minds of people. Nora (1989) draws
his own distinctions between memory and history, arguing that memory
is the living past (still reconstructed), whereas history is an attempt at
The relationship between memory and history 101
reconstruction, which will always be incomplete. This is in accordance

with the distinction used in this book. History is how our hopelessly
forgetful modern societies, propelled by change, organise the past
(p. 8), while memory is life, borne by living societies founded in its
name. It remains in perpetual evolution, open to the dialective of
remembering and forgetting . . . vulnerable to manipulation and appro-
priation, susceptible to being long dormant and periodically revived
(p. 8). Further, history . . . is the reconstruction, always problematic
and incomplete, of what is no longer . . . History is a representation of the
past. Memory, insofar as it is affective and magical, only accommodates
those facts that suit it; it nourishes recollections that may be out of focus
or telescopic, global or detached, particular or symbolic (p. 8). In other
words, according to Nora, memory is, by its nature, multiple and yet
specific, collective, plural and yet individual. History belongs to every-
one and no-one, whence its claim to universal authority. While societies
and individuals take responsibility for memory, who takes responsibility
for history? In the end no-one, as it has a way like science of standing,
or appearing to stand, outside society, applying the historical microscope
and objectively interpreting and recording the past, irrespective of
society. History annihilates the mnemonic past through the objective
systematic record.
Nora presents a strong argument, if a little extreme to the eyes of a
psychologist. According to both Hutton (1993) and Nora, the crucial rift
between memory and history occurred in the nineteenth century, when
historiography took possession of what had been memorys territory.
History attempted to reclaim the past with the strong intent of forging
national consciousness; that is, historians provide politicians with a
means of providing a past that is the same for everyone in society, where
there is no room for memory (the later popularity of oral history may be
a claim to restore memory to the people). In the end, according to Nora,
memory has retreated to what he calls lieux de memoire sites of
memory. These sites are exemplified by everything from funeral eulogies
to battlefield monuments, memorials and museums. Memorials are
discussed later in Chapter 12.
Hutton (1993) argues that historys work of imagining and recollect-
ing the past ultimately interferes with memorys work of holding the past
close and repeating it. Furthermore, he argues that there is interplay
between memory and history, with two key themes. The first is repetition
(associated with memory) and recollection (associated with history).
This is the foundation of the history/memory problem. The second
theme is the impact of the shift from the oral to the literary tradition
and the development of subsequent technologies regarding changing
conceptions of memory. This shift is illustrated again in the work of

Nora, who says that society has an obsession about remembering every-
thing. We attempt the complete conservation of the present, as well as
the complete preservation of the past. Nora has a good point. If we try to
remember everything, we are likely to remember nothing, because
remembering is not mainly about the input of information into the brain;
it is about how that information is organised and used. If information is
simply stored, it is of no value. Furthermore, the preservation of the past
can be problematic. It creates a heritage society, one looking backwards
rather than forwards. A heritage society means well in attempting to
represent the past in a particular way, but the reality is that it is fixed,
focused and depends on a particularly prevailing political viewpoint
about the past, and takes away the ability of people in society to use
heritage sites for todays purposes, rather than fixing them in aspic to
provide a single view of the past.
As we shall see in Chapter 12, memorials can do the same but, used
effectively through remembrance and commemoration, they can look to
the present and the future it depends on whether the focus is on living
memory or dead history the life of those doing the remembering, or the
history that is the events where the remembered died. The heritage
industry that preserves, for instance, ancient buildings is not looking to
the future; it is historical fixation, or heritage. For instance, Wingfield
Manor, a fifteenth century Derbyshire manor house built for the then
Chancellor, Ralph Lord Cromwell, sits atop a hill, a ruin used mainly for
film and television (though it contains a working farm). The heritage
industry spent several million pounds on preserving the ruin in a ruinous
state a twenty-first century folly rather than spending money on
turning it into something useful for the present and the future. This
can be contrasted with Spain, where the government, in 1928, set up the
Paradores, a series of luxury hotels set in (often) historic buildings such
as castles and monasteries. These ancient buildings are carefully restored
to something of their former glory, but with modern conveniences such
as comfortable bedrooms, air conditioning, central heating, swimming
pools and excellent restaurants serving local and seasonal food. They
look from a distance as they might have done hundreds of years ago, but
inside is luxurious. If Wingfield Manor had been rebuilt, carefully
retaining its fifteenth-century nature but including twenty-first century
technology, as a hotel and restaurant, then society would have something
functional and beautiful still historic, but useful to modern society and
looking to the future. This demonstrates the importance of the relation-
ship between culture and history. British culture tends to favour heritage
over the living past, and heritage enables history to dominate memory,
Shifting perspectives: from memory to the past to history 103
fixing the past in aspic. From the example of the Paradores, Spain uses
the past to look to the future, illustrating how memory (living, breathing,
personal and social) has the ability to remember what is important about
the past, and to make use of this in a way that is beneficial to the present
and the future. History in the shape of heritage - fails to do this. This
does, to some extent, support the views of Nora (1989), who is very anti-
history, arguing against the terrorism of historicised history (p. 14),
yet highly supportive of memory. Heritage should be contrasted with
academic historians, who debate the meaning of the past in ways pertin-
ent to the present, attempting to provide a historical context that is
meaningful in the terms of both past and current society.
Shifting perspectives: from memory

to the past to history
At several levels, the shift from memory to the chronological past and to
history is important. The societal level, described by Nora, concerns
how we now record more information in a written form, on-line, through
photography and by other means. This ever-increasing archive of the
past provides historians with so much information that they are unlikely
to be able to organise, analyse and synthesise it all, even if such a goal
was desirable. From this perspective, we can see how memory shifts to
the past through increasing technology and on to history through liter-
acy, the science of history and mass education. Once information is
recorded in a book or on the Web, the epic poet has no further purpose.
It is rather ironic that the more education one receives, the less value is
placed on memory.
There is a transition from memory to a sense of the past (the term
history does not refer to the past, but to an interpretation of the past by
historians) over about three generations. This is a normal psychological
process, with the experiencing generation having a memory of what they
have experienced, their children taking on those memories in a weaker
but nevertheless still memoric sense, and their children perhaps still
having a sense of memory from listening to their grandparents. After
this generation, the events fade into the past as there is no-one left who
experienced the event and can impart it directly or indirectly into the
following generations. The memory, as it is transmitted through the
children and grandchildren, may become a collective memory if it relates
to a major societal event, or it may remain a familial memory if related
specifically to the family.
A specific example may make this clearer. The First World War, as it
had such a major impact on both the individuals who fought and on
society as a whole, was remembered deeply by the soldiers who had

fought and by their families at home. It became a central part of their
narratives, their life stories. When these people married and had chil-
dren, their memories of the war were passed down to the next genera-
tion those who did not remember the war but lived it constantly
because they were so close to the participants. These memories might
be the stories told to them by their parents or others, or they might be in
the behaviour of people, from the physically wounded (my own father,
born in the First World War, told me of a man who used to stand in an
alley in the village who would show the young lads his wound by sticking
his finger through the hole in his arm) to the traumatised (I remember a
veteran of World War Two who would regularly make loud grunting
noises in the local pub; initially it was comical to we teenagers, but we
found out it was a result of his wartime experiences and it stopped being
funny), and include commemorative events such as Armistice Day,
along with the living families who had lost a family member during the
war. These children developed their own strong memories of the war,
perhaps having an emotional reaction to the words Somme and
Passchendaele in a similar way to their parents. To them the war was
still memory, not the past, not history. When the stories pass down to the
next generation, the grandchildren, they may still be called memories
because the information is passed from the mouths of the participants,
but this is also the period when memories of an event become descrip-
tions of the past, something that has little immediate relevance to the
current generation. It is also the time when academic historians and
others, such as novelists, start to turn the period into history. That has
now happened to the First World War, and it is beginning to happen to
the Second World War. This chronological sequence occurs because
memory is concerned with that which is relevant to the people living in
society. Once the participants of an event are dead, the event usually
loses its immediate relevance, though major events such as war can
remain highly relevant. In this case, such events are remembered
through commemorative events, museums and Noras lieux de memoire.
In these ways societies continue to remember the past in a way that is
significant and meaningful in the present. These key societal events
remain in collective memory.
The transition from memory to history is important to psychologists,
and has been little studied. The work on inter-generational transfer of
memories has focused largely on traumatic events, such as the Holocaust
or sexual abuse, but the basic psychological processes are the same
whatever the event being recalled. The arguments regarding how the
past is transformed into history, or how collective memory is transformed
Social continuity 105
into history, or how these are all transformed into heritage are really
beyond the scope of this book, though they have relevance for our under-
standing of the past.
An illustration of the transition from individual to collective memory
can be seen in the ways that novels emerge. Immediately after major
wars, many accounts, including fictional accounts, were written by the
participants (not just soldiers). For about 1520 years, very few novels
emerge; then, once most of the participants are dead, there is another
flurry of novel writing. This can be seen in relation to the First World
War through novels written after the war by Erich Maria Remarque,
Henri Barbusse, Rebecca West, Siegfried Sassoon and others. There was
then a period when fewer novels were written, and it was only after most
participants were dead that WWI novels again became popular, through
work by Pat Barker, Sebastian Faulkes and others.
Social continuity
Collective memory ensures continuity in a community. It is the way in
which we preserve our collective knowledge and pass it on from one
generation to the next. This enables future generations to construct their
own personal and social identities, constructing the present by building
on the past. Having social or collective memories ensures that members
of a community share a sense of unity. This can work at all levels, from
the village in which all men once worked in the same pit, and so have
shared experiences, to the country that has a shared memory of the role
it played in the Second World War. Individuals are linked to social
memories. Most people in England will have knowledge of individual
members of their families who fought in the First and Second World
Wars. Most communities have war memorials which show how individ-
uals from that community shared in the common social goals repre-
sented by those wars.
This sense of social identity is important; it is more important than
having accurate objective memories of the past. In terms of the Second
World War, it is more important to have had a member of the family who
fought in that war and so contributed towards the greater good than to
know that perhaps that person was a coward or a thief who stole from his
comrades and ran away from the enemy. During World War Two, the
British displayed the stiff upper lip, the ability to stand firm against all
adversity. Of course, at one level this was nonsense people broke down,
they failed to cope but at another it was a necessary idea, a necessary
collective ideal that helped the nation through the difficult years of the
war; and after the war it became a collective memory. People looked
back and thought that they pulled through those years at least partly
because they had a stiff upper lip. This was portrayed in many of the
war films that emerged during and after the war, such as Dambusters,
Reach for the Sky or The Longest Day (USA).
We reconstruct the past in ways we wish to reconstruct it, with little
consideration for any objective truth. Collective memory does not
involve testimony about the truth. This is even the case in a courtroom,
which is an entirely artificial situation with regard to memory, where
witnesses are expected to recall the past with a degree of accuracy and
details that as psychologists we know is hardly possible. Witnesses
statements will also be influenced by the groups they are in, by the police
officers and lawyers who question them, and by the narratives they have
constructed about the events in question.
Our identities are tied up with memory and history. Without memory
we have no identity. In order to create our identities we draw on cultural
memories and historical understanding of our cultures. Remembrance
of the past is important in terms of our socialisation into our culture.
Family traditions are also important in this.
The nature of collective memory

There has been a lot of work on collective memory in a number of
disciplines, though there is dispute about its ontological status. The
construct has proved unpopular among many psychologists, perhaps
because of concepts such as Jungs collective unconscious, which some
have thought entailed some kind of spiritual connection between minds.
Here, collective memory does not imply connectedness beyond the usual
forms of social interaction.
According to Halbwachs (1992), all memories, except dreams, are
social. That may be why it is difficult to remember dreams; they are
always out of a social context, and so the cues for memory that may exist
in waking life may be absent. The disorganised nature of dreams may be
precisely their individuality, showing how the social is critical if we are to
remember them though there is limited evidence for this. Nora (1989)
notes that the less that memory is remembered in a collective manner,
the more the individual has to remember, unless there are the means of
storing memories outside the mind. In technological society these stor-
age facilities are widely available in, for example, books or the Internet.
The problem is that such information, unlike memory, is not organised,
and so, if we reduce the importance of collective memory by storing
information on the Internet, then it becomes more difficult to establish
both individual and societal identities. As an example of increasing
The nature of collective memory 107
disorganisation, 20 years ago a rock group would present an album in a

structured, organised manner, listing songs that were intended to be
played in a set order. With the advent of memory devices that can hold
thousands of songs, the concept of the album (the structured) has been
lost, and listeners are faced with playing songs in a random and mean-
ingless fashion (the unstructured). The random shuffle means that
music becomes fragmented, losing its identity and coherence, in a simi-
lar way to how individuals, without the support of their community
through collective memory, lose their identity.
Collective memory is very similar to Noras (1989) lieu de memoire,
a memory environment entwined in the intimacy of a collective herit-
age . . . ceaselessly reinventing tradition and linking the history of its
ancestors to the undifferentiated time of heroes, origins and myth
(p. 285). Whereas history is reinforced by writing, collective memory is
reinforced by social occasions such as rites and commemorations
(Favorini, 2003). Folklore and myth are particularly important in col-
lective memory. We are all aware of our nations folklore. This binds
together the people within a society and aids the development of moral-
ity and behaviour deemed appropriate to society. For instance, in Eng-
lish society, Robin Hood is important to childrens understanding of
what is morally right and wrong. It is a simple argument that it is right
to take from the rich and give to the poor. This is expressed in society
through taxation. The nation is lived through the internalisation of
myths and ideas about the nation (Knox, 2006). The national com-
munity is developed and maintained through the practice of national
traditions and acts of remembrance (Hobsbawm and Ranger, 1983).
Collective memory can be developed in a number of ways. Thelen
(1990), having a concern about whether people remember accurately
and as research has shown they do not (e.g. Bartlett, 1932) states
that collective memory is developed by people in groups, discussing
memories, debating, arguing, and coming to conclusions about what
happened. That is, they debate over the meaning, and come to a
collective decision, creating a collective memory. The debate continues.
It takes place at all levels, from discussions between people in the pub,
to the media. The information is considered from all angles, and a near
consensus emerges (there will always be dissident minorities). When new
events occur, these are discussed and integrated. Collective memory is a
living process in a way that history is not; though historians may
disagree, their debates are essentially academic rather than functioning
at the level of the individual in society. While historians conclusions
depend on current societal mores, they debate the past as history, not
as memory.
The impact of collective memory on individuals

In some ways it is not possible to separate the past and the present,
because the way the past is interpreted inevitably impacts on the present.
An extreme example is the Soviet Union under Stalin, where people
who, for whatever reason, had been declared non-persons were eradi-
cated from the historical record, including being brushed out of photo-
graphs. This was well described by George Orwell in the novel Nineteen
Eighty-Four, where Winston Smiths job was to alter past newspapers to
provide a representation of the political leaders views in the present.
This has a truth in all societies. Every reading of the past is in itself a
narrative which owes its meaning to the ways we, in a community, wish
to interpret the past. This is true of both history and memory, in the
sense described above. Historians work within their society, and inter-
pret the past in the light of the moral and ethical codes of the present,
and the social mores and norms of society. Individuals do exactly the
same thing, interpreting their past memories in terms of their present
social experience (as will be explored in the next chapter). So, in a very
real sense, the past is incorporated into consciousness, and the present
and past are fundamentally linked. Within the study of memory it is
pointless to discuss whether or not a particular memory corresponds to
the actual objective past. What we should be concerned with is how
and why the memory is constructed as it is. Two people who lived through
the same objective experience will have different memories of that
experience, and the experience will have affected them in different ways.
Unless there is a legal issue, or there is a reason to demonstrate that
someone is lying, it is fruitless to argue who is right or wrong. The reality
is that both are reflecting accurately on their memories, and both have a
different consciousness because of their experience. Geary (1994) argued
that, because of these factors, there is no sharp distinction between
individual and cultural or social memory. In order to understand memory
(and history), we have to understand the context of the present.
Oral history
Oral history hovers between academic history and collective memory in
our attempts to understand the past. Modern oral history approaches are
a shift back towards the tradition of collective memory rather than the
objectification of the past in traditional academic history. It is an accept-
ance that what people actually say about their pasts is meaningful and
relevant. The journal Oral History has done a great deal in highlighting
the history of the ordinary person, as opposed to the faceless but
Politics, memory and history 109
important people in much social history the politicians, industrialists

and generals of traditional history.
Oral historians access the memories of participants to describe par-
ticular historical events from a personal perspective. In historical circles
it is sometimes seen as a contentious and radical form of examining the
past, focusing on the memories or narratives of specific individuals to
make an important contribution to our understanding of history. Oral
history helps us to understand the world of our parents and grandpar-
ents but has a limited contribution to make to our understanding of
memory beyond confirming the constructed nature of memory. While
oral history makes no claims to understanding the processes of individ-
ual memory, it does bring together individual memories to help develop
collective memories of particular events or times, taking on a formalised
role normally carried out by groups. Perhaps Nora sees this as another
way in which memory is destroyed by history, though oral historians may
contend that individuals memories are worthy repositories of past
events, which it is appropriate to reconstruct.
Derderian (2002) notes that, while official histories are losing their
influence and legitimacy within modern society, private citizens are,
through oral history, being required to do more memory work. For some
traditional historians, the problem with oral history is that it is subjective,
and so it is not a sufficient means of understanding the past. As shown
above, memory (and hence oral history) is intrinsically subjective at several
levels. People may choose to recall or not recall particular aspects of their
past. For instance, if a person has been a perpetrator of war crimes, it is
likely that they will choose not to discuss memories of these events. On the
other hand, a victim of such crimes may focus on them in some detail.
Subjectivity is selective, with people only being able to draw on elements of
an event in the past, the elements they experienced and remembered.
While oral history is a legitimate discipline, we should not be over-reliant
on it. Oral history can be a means of legitimising oneself and ones
own beliefs and attitudes, by providing a justification for behaviours.
This is exemplified by the experience of the Balkan wars of the 1990s,
where nationalists justified themselves through relating selective discourses
regarding events going back to the Second World War and beyond. For the
Serbs, even back to the Battle of Kosovo Polye in 1389, which has a strong
oral tradition (see Judah, 2000, for a discussion of Serbian discourses).
Politics, memory and history

The South African Truth and Reconciliation Commission set up after
the end of apartheid, demonstrates how society can influence the kinds
of memories that are recalled after crimes. The commission succeeded in
drawing together the disparate elements of South African society in a

way that many thought impossible in a very short time. By enabling
perpetrators to admit their guilt through the commission in exchange for
a form of societal forgiveness, the deep wounds engendered by apartheid
were at least partially healed.
Memories are manipulated by the state and by political groups, often
for what are generally seen as positive reasons, such as the binding
together of people after a war (see Chapter 12 on memorialisation and
commemoration). Sometimes there are less positive reasons. Graham
and Shirlow (2002) describe how, in Northern Ireland, there is compe-
tition among the religious groups for the mythology of the Somme
(in 1916 the 36th Ulster Division was one of the first divisions over
the top on the first day of the battle near Thiepval and suffered huge
casualties). The Unionist narrative concerns how the Ulstermen were
helping the British in their fight against the Germans, whereas the
Loyalists take an alternative position, seeing the battle as a betrayal by
the British. This betrayal, which initially involved an attempt by the
British Government to kill off as many troublemakers as possible on
the Somme, is extended to the betrayal they perceive has occurred since
1969 in Northern Ireland.
It is difficult to generate political inclusivity in collective memory after
a civil war. In Bosnia, since the Dayton Agreement in 1995, it has been
very difficult for people to erect memorials because of the difficult
political situation. The Bosniaks (Muslims), Serbs and Croats still
effectively run separate statelets within the state, and there is little desire
for memorials recognising the loss of life throughout the country. Even
when memorials are set up to represent some aspect of the war, these
may be quickly defaced. For example, this has applied to memorials set
up by the Bosniaks commemorating the dead at Srebrenica, and to a
memorial set up to commemorate the women victims of the Serbs in
eastern Bosnia, an area within Republika Srpska that is still dominated
by the social discourses of Serbian nationalism.
Another way in which memory and history are manipulated is how the
victor in any war determines the past through official histories. There is
selective forgetting about the role of each side in the war. For instance,
after the Second World War there was much written and spoken about
atrocities committed by the Axis powers, Germany and Japan, but very
little about allied atrocities. This selective memory is common not only
in individuals, but also in objective histories. Take, for instance, how
histories of World War Two are written by British, French, American,
Russian and Chinese authors. The story of the war is very different.
The French experience something similar regarding the Algerian war
Politics, memory and history 111
(Derderian, 2002). For the British, a current concern is the representation

of the colonial period, the behaviour of British forces in India, Africa and
elsewhere. Only when the participants are old or dead (and hence not a
threat) do we reawaken old memories of war and attempt to develop a
redress regarding biased remembering. It is unclear whether this is out of
respect for the participants or out of a fear that releasing unpalatable
memories will lead to social disruption.
The impact of politics and memory on the individual is vividly dem-
onstrated in the work of Einhorn (2001), who described a generation of
German women who were forced to change their life stories on several
occasions because of historical changes in social discourse. They were
brought up as Nazis in Germany until 1945, when they were ejected
from Germany, only to return as Communists to East Germany in 1946.
After the fall of Communism in 1989, they had to fundamentally alter
their life stories again. Each change requires a fundamental rethink of
the personal life story, and hence memories. Kamierska (2002)
described how Polish land-owning women who survived the Second World
War had a similar problem. Before the war, Poland was an independent
state, and women played a particular role in society as a crucial part of
the family. After the war, under the Communist regime, the Communists
encouraged the forgetting of pre-war memories and the establishment of
new social structures where the family played a more minor role.
Memory, history and politics are also linked with memories of the
English Civil Wars of the 1640s. These conflicts were remembered for
longer than most because of the major impact they had on English
society. It is estimated that around 200,000 people 3.5% of the popu-
lation died during these wars. According to Carlton (1991), it was, in
relative terms, the bloodiest conflict fought by the English. On the
accession of Charles II in 1660, the anniversary of his fathers execution
(30 January) was to be remembered by society for the sins committed
during the civil wars. Sermons praising the memory of the late king
and condemning the rebellion were preached in churches every year
(Stewart, 1969). The second date that continued to be celebrated into
the twentieth century was 29 May, the anniversary of the accession of
Charles II. It became, and remained for many years, one of the high
points of the festival calendar (Stoyle, 2004). People wore oak leaves,
and decorated their houses with oak wood, to commemorate the night
Charles had spent hiding in a tree to avoid the Parliamentary troops. Of
course, the supporters of Parliament would have been unwilling to
commemorate this date, and so the civil war rivalry was likely to flare
up again between supporters of the opposing camps. In Tavistock, in
Devon, rival groups would engage in mock street battles representing
the opposing camps until the nineteenth century. Remembrance of the

Parliamentary side often had to be kept quiet. In the eighteenth century,
supporters of Cromwell, known as the Calves Head Club, met secretly
on 30 January every year to celebrate the anniversary of Charless exe-
cution by eating a calfs head (Stoyle, 2004). Though there had been a
lot of support for Charles I, and Oliver Cromwell was, for centuries,
compared to the Devil, social constructions about historical memory
do change; when New Labour won the 1997 election, several members
of the Cabinet requested portraits of Cromwell to decorate their offices
(Stoyle, 2004).
This is tied up with the importance of forgetting. In the above
examples, the people were encouraged to forget about their previous
status, and focus on the present and the future. This encouragement
usually comes from within as well as externally. A good example was
presented by Connerton (2008) in an article entitled Seven types of
forgetting. He discusses forgetting as humiliated science, showing how
societies choose to forget certain events. Around 130 German cities
and towns were destroyed during the Second World War, and around
600,000 German citizens were killed, along with the loss of around
3.5 million homes, leaving 7.5 million people homeless. The occupying
forces saw and described the survivors as being utterly lethargic,
wandering around the ruins without purpose. But few people German
people have written about these times, either immediately after the war
or in the decades since. This is hard to explain, but Sebald (2003) wrote
about how his teacher had seen the corpses in the street, and observed
them in a similar way to how people view pornography, furtively and
with a sense of shame. According to Sebald, the main emotions felt by
the German public were humiliation and shame probably for both the
defeat in the war and the support, whether implicit or explicit, for the
Nazi government, which had caused so many problems and represented
something evil. Connerton (2008) notes that we cannot infer forgetting
from such silence; just because people do not speak of a thing does not
mean they forget.
Another example, also discussed by Connerton (2008), is that of the
Great War, which led to massive memorialisation and commemoration
for the dead. It has been estimated that around 10 million mutilated men
were walking the streets of Europe in the 1920s: blind, crippled,
with gross facial disfigurements, mainly badly cared for. The commem-
orative events focused on the glorious dead. Societies were ashamed of
the living maimed; they were dismembered not remembered men
(p. 69). In more recent years, there has been a growing recognition that
the beneficial purpose of commemoration is to remember the living as
Conclusion 113
well as the dead, to remember the veterans who fought in wars and
survived, whether wounded or not, and to remember the families who
survived bereavement and loss. This notion of remembrance is perhaps
easier when we are looking back into the more distant past. After the
First World War, and less so after the Second World War, the shock of
loss focused society on the dead. In recent years we do now recognise the
need to remember the living.
Conclusion
The central constructs discussed in this chapter history and collective
memory are interpreted in different ways by academics of a number
of disciplines. The purpose of the chapter was to provide an overview of
the constructs as they are used in this book, as they are used for the
purpose of broadening our psychological understanding of the individ-
ual response to traumatic events. This chapter should not be read as a
criticism of the discipline of history; no such criticism is intended. The
intention was to highlight how history detracts from our full understand-
ing of how memory works in the social world and across generations.
Memory is crucial. People need to remember the past in order to have a
successful present and future, in order to be able to interpret what has
happened to them in the past. This is not just an individual process; it is,
as Halbwachs would argue, a social process. We turn to this interaction
between the individual and the social in the next chapter.
8 Personal narrative and social discourse
The previous chapter demonstrated the role and importance of the past
in enabling individual understanding. This chapter moves to the pre-
sent to show how the social world plays a crucial role in determining
how we think about ourselves and the world. In order to develop a
complete theory of the response to traumatic events, it is critical to
consider the response, not only from the psychological perspective, but
also the broader social world. War trauma is not an individual disorder.
It arises out of a complex interaction of personal, social, cultural,
historical and political forces the relationship between the personal
narrative and social discourse building on the discussion in the
previous chapter.
The personal narrative has already been touched on, but here it
is considered in more detail, particularly with regard to the role of
narratives and how they are developed. William James (1890, 2007)
was one of the first to establish psychology as the science of the mind,
which since has mainly been conceived as the science of the individual
mind. More recently, researchers have recognised that the attribution
of psychological traits is not the exclusive domain of psychology and
the cognitive sciences (Wilson, 2005), and that other disciplines con-
tribute to our understanding of the mind simply because the mind is
socially and culturally situated, and cannot be seen outside of that
social context. Attempting to understand the individual mind without
recourse to the social aspect is always going to limit the efficacy of any
theory.
The key point is that there is a constant interaction between individual
(narrative) and social forces; the individual draws on the social context in
order to make sense of the world, and the social context itself is derived
from a range of sources, including the media, academic argument (e.g.
in history or sociology), government policy and other sources where
individuals interact. The flexibility and fluidity of narrative and individ-
ual narrative change is crucial. This relates strongly to the development
and treatment of war trauma.
114
Narrative 115
Narrative
As discussed in the last chapter, humans are prolific storytellers; it is
what we do best. In low-technology societies, the epic poet would keep
the past alive through reciting the deeds of great people in the society,
providing the context for current discourses and showing how people
within a society should live. Even now, we use stories in a vast number of
contexts: from entertainment whether telling a child a bedtime story or
reading a novel to developing understanding of the world by listening
to news stories or reading magazine and journal articles, to gossiping to
each other about the latest events and about friends and acquaintances,
to the more detailed stories we tell ourselves and others about our lives,
the stories that are our autobiographies life stories should be pluralised
because we have alternative versions for different people and situations.
I have one narrative of my past that I would share with my students, but
a very different one I might share with my close friends.
Narrative is necessarily complex; a good story has a number of
elements. It must have a sense of time, with one event following another
in a logical sequence; the events themselves play a key role. They are
included because they have some importance. There is a context, with
each event being set in a particular situation for a good reason. There is
the format of the narrative whether it is oral or written, and in which
style it is presented. There is cohesion, so that the story hangs together in
a meaningful way. And finally, there is the important notion of agency.
The person who is telling the story owns it; it is that persons story to
present as he/she wishes to whoever he/she wishes. This then links to the
plurality of narrative. We all have numerous narratives, many intercon-
nected, that we use with different audiences at different times.
The narration of experience is not only very widespread, it does
appear to be essential for health, and that health gains can be made as
a result of such narration (Pennebaker and Graybeal, 2001). Storytelling
is not optional it is something we have to do; we are compelled by our
nature to create narratives. According to Gergen and Gergen (1988), we
select and organise our personal memories to build a coherent sense of
the self and establish and maintain our identities (see also MacIntyre,
1984). Wrye (1994) noted that personal stories are not just about telling
stories; they are the means by which identities can be fashioned and
developed. People need to make meaningful sense of their experiences
through the use of language and stories. This relationship between
narrative, self and identity is central to our understanding of the
response to trauma, and links with the social constructions that help to
build notions of self and identity. According to Squire (2000), narrative
research helps us to explore how the self is developed out of our cultural
resources (or social constructs, see below), and how we believe that our
lives need to have a certain shape or structure (narrative) which has
personal identity at the core. In this sense, narrative is the performance
of the self in the sense of self-identity.
Kihlstrom (2002) argues that memories are reconstructed in accord-
ance with our theories of self our personal views regarding who we are
and how we got to be that way. Autobiographical memory (how we
remember our own past) is a part of the personal narrative, reflecting
our views about ourselves. These views do not (as Freud claimed)
necessarily derive from our childhood experiences; this is a nave per-
spective given the importance of the social world. A more interesting
perspective is that of Adler (1958), who proposed that memories of
childhood can change if the current personal narrative changes. This is
because childhood memories remind us of who we are now. In other
words, as Ross (1994) argued, people, through narrative, reconstruct
their personal histories around their tacit theories of the self, revising
their histories as their self-concepts (narratives) change.
As we have seen, narratives are systems of personal knowledge
(Crossley, 2000). The turn to narrative in psychology (e.g. Bruner,
1990), provided an important opportunity to develop our understanding
of memory processes. Narrative involves the attempt to develop a coher-
ent past, which involves over-emphasising the role of some events (mem-
ories) and under-emphasising others (perhaps memories about which we
are embarrassed, or which do not fit our current conceptions of our-
selves). Narrative is about making sense of our lives, integrating the past
with the present with a view to how we intend to live our lives in the
future. Because our lives can change, either dramatically, or in a slow
evolutionary manner, we are constantly updating our personal narra-
tives. This may involve confabulation (Bartlett, 1932), or selective
remembering and forgetting. Other factors may also impinge, such as
personality (Pals, 2006), coping styles, social support, our friends and
family (Burnell et al., 2006), age (Coleman, 2005), personal experience
and the social world.
Research into narrative can help us to develop our understanding of
memory. Narrative researchers have explored how memory works in a
number of fields. Psychologists have focused on the impact of traumatic
stress, and how individuals learn to cope with their memories by cogni-
tively processing emotional content through narrative, attempting to
understand their trauma by making it meaningful (Linley and Joseph,
2006; Ness and Macaskill, 2003). Twentieth-century examples include
Simon Westons charitable work after being heavily scarred in the
Narrative 117
Falklands War, Oliver Stones dealing with his own Vietnam experience
through the production of a series of Vietnam War films or Pablo
Picassos representation of the bombing of Guernica during the Spanish
Civil War. Creating a coherent story about a traumatic event is essential
to trauma recovery (Herman, 1992; Brewin et al., 1996). Such narratives
may provide positive benefits for the individual, particularly in terms of
helping to resolve traumatic issues through narrative development.
Narratives may or may not correspond to reality. There was a debate
in the 1990s regarding recovered memories, where it appeared that
traumatised patients were, with the help of therapists, retrieving sup-
pressed stories of child sex abuse which, it was claimed, was the cause of
the person being traumatised. Many cases came to court, and parents
and other carers were convicted of sex abuse largely on the basis of
stories that emerged in therapeutic sessions. The therapeutic environ-
ment is one in which vulnerable patients can be induced, through
discussion with therapists, to develop a rationale for their problems,
and this rationale can be based on entirely fabricated memories. This
is not to say therapists deliberately attempt to manipulate memories,
but that, through conversation, patients find ways to explain their
feelings, and these explanations can be non-consciously fabricated.
The recovered memory debate is largely over, but is an effective demon-
stration of not only how trauma narratives may not be objectively true,
but also how within the profession social constructions (in this case
recovered memories) can dominate at a particular time.
Knapp (1988), discussing the context of biblical stories, asked why it
should ever matter whether a narrative corresponds to reality. This is
relevant to the current discussion because, except for certain contexts
(e.g. law) where we do want a narrative to be accurate, in other contexts
objective truth is irrelevant. It does not matter whether biblical stories
are an accurate representation of the past; what matters is that there is,
for Christians, a foundation for their faith. In the context of war trauma
narratives the situation is complex. On the one hand, when treating
victims of war trauma, it is more important to reduce symptomatology,
and if this means some fabrication within the narrative, then that can be
of little importance though the case above of recovered memories
shows how this can go wrong; on the other hand, if victims narratives
are potentially going to be used as witness testimony (e.g. narrative
exposure therapy, Shauer et al., 2005), then the narratives should be as
close to the truth as possible.
In everyday life these errors and distortions are common. In a sense
we all go around hiding the truth (though it may be portrayed as
projecting the right image). This is the case in the narratives we call
autobiography and those we call literature, which obviously leads to

problems in establishing an accurate record of the past. For example,
Binjamin Wilkomirski (1995), in Fragments, provided an account
fragmentary, as in the title of a young childhood spent in Nazi camps.
The book initially received a great deal of acclaim, won literary prizes,
and was later shown to be false. The account is entirely fictitious, based
on Wilkomirskis reading about the Holocaust and others experiences in
the camps. Another example is the book entitled I Rigoberta Menchu:
An Indian Woman in Guatemala (1983), which described a womans life
during the Guatemalan civil war. The book won the author the Nobel
Prize, but again was later shown to be a fabrication, because the author
could not have witnessed many of the things she claimed to have wit-
nessed. This genre, which appears to be growing, is often known as non-
fiction fiction, as it is often based on true stories that have been brought
together in a single narrative.
We know that memory is complex, and that it is constantly recon-
structive, focusing on the more salient features of life experience
importance, uniqueness, imaginative elaboration and confabulation
(Bartlett, 1932). There are both personal factors (importance of event,
distance in time, illness and disease, narrative) and social factors (social
and cultural discourses, interaction with other people) which impact on
what we remember.
An interdisciplinary approach is beneficial to understanding how
memory changes. Freeman (1993) draws on psychology, philosophy
and literary theory to examine the ways by which people reinterpret
the meaning and significance of past experience. If we are to fully
understand how memory works, we have to look outside of the psycho-
logical laboratory and research people living their lives. Freeman is
partially right in looking at the contribution of other academic discip-
lines, but for a fuller understanding we need to look more broadly at
memory function.
Trauma and narrative

Many, if not most, theories of traumatic stress discuss the important role
of narrative, even if the term itself is not used. As previously discussed,
Pierre Janet was one of the first to acknowledge its importance, with his
view that resolving a traumatic experience was about turning a traumatic
memory into a narrative memory, i.e. turning a memory that is dis-
jointed and incoherent into one in which the memory of the traumatic
event is integrated into the life story. This notion is at the heart of most
theories of trauma, implicitly if not explicitly.
Trauma and narrative 119
Many current theories of PTSD suggest that trauma is the result of

enduring maladaptive responses which have impacted on the individuals
autobiography or life story (e.g. Brewin et al., 1996; Foa and Rothbaum,
1998; Brewin and Holmes, 2003; Nemeroff et al., 2006). Autobiograph-
ical memory is organised primarily around narrative structures, so if
traumatic events impact on autobiographical memory, they inevitably
impact on narrative and narrative development.
As shown in Chapter 5, the core of trauma is the traumatic memory.
While we integrate our normal life memories into our narrative,
traumatic memories are not so integrated. Traumatic memories are
dominated by sensory, perceptual and emotional components, com-
ponents which are harder to integrate into the conscious narrative as
they do not normally have verbal components. This means that they
will have fewer interconnections and weaker organisation (OKearney
and Perrott, 2006).
OKearney and Perrott (2006) reviewed the literature for trauma
narratives in PTSD. They used two key criteria for selection. The study
had to include a linguistic analysis of the narrative, and ratings of
narrative or memory quality. Studies also had to have an appropriate
control group such as people without PTSD, non-trauma narratives, or
non-intrusive narratives; an examination of how an individual partici-
pant changes over time with or without treatment; and a study of the
association between narrative measures and PTSD symptom severity or
symptom change. This restrictive but appropriate set of criteria led to a
selection of nineteen studies being included. As there was a great deal of
heterogeneity in the studies, which would not allow any meta-analyses,
the analysis was qualitative. The focus was on four areas of concern to
the narratives: (1) sensory, perception or emotional dominance in the
lexicon, (2) narrative disorganisation or fragmentation, (3) disrupted
temporal context, and (4) the nature of references to the self. The results
showed support for the prediction that sensory and perceptual elements
are more highly represented in PTSD narratives, but there was relatively
little evidence for PTSD-related disturbances in narrative organisation
and self-referential themes. There was tentative support for PTSD dis-
turbance in the temporal organisation of the trauma narrative, but the
data were inconclusive. OKearney and Perrott conclude that there are
too few high-quality studies on which to base any conclusions regarding
self-referential themes. There were also similar problems relating to the
fragmentation of memory. While clinicians argue for this fragmentation,
and it is implicit or explicit in many theories, there is limited evidence
either way. This is not because the theories lack potency, but because the
studies are just not good enough. As we saw in the chapter relating to
methods, there is a range of good narrative methods available. It is just

that trauma psychologists are not using them, or not using them enough.
OKearney and Perrott (2006) also argue that part of the problem is
theoretical, relating to the complexity of language structure (see also
Martin, 2003; Graesser et al., 2004). Fragmentation can be seen not as a
simple breakdown of complex linguistic process, but as relating to two
linguistic processes narrative cohesion or connectedness, and narrative
coherence or conceptual organisation. These demonstrate different ways
in which narratives can be fragmented. Cohesion focuses on temporal
and causal relationships, focusing on the relationships between sen-
tences or clauses, i.e. the basic building blocks of language, whereas
coherence focuses on the connections of goals, actions, topics and
events, i.e. the underlying meaning rather than the surface structure
(Sawyer, 2003).
Interpersonal and social discourse

Cultural stories and social discourses are cultural codes that shape
collective processes and identities. These are, according to Baars
(1997), related to deep-rooted narrative traditions, often literary, such
as Ulysses, Don Quixote or Shakespearean characters. These embody
the intelligence and wisdom of a society.
Cultural narratives are now transmitted through the media to a greater
extent than through literary or oral sources (e.g. the Challenger disaster,
the death of Princess Diana, ethnic cleansing in Bosnia), but this only
focuses on social ideas about ageing. It is much more important to
understand how individual narratives are developed using media dis-
courses. Most people would agree that the media is important in shaping
peoples attitudes and beliefs, but we need to go further than that and
recognise that memory and identities are also shaped by the media. We
cannot understand memory without drawing on the social and cultural
influences of memory.
Bornat et al. (2000) have studied family and change, examining ageing
members of families who have experienced break-ups, and found that
attitudes towards family break-up have changed over the years. She used
respondents who worked with their own memories of family change, yet
at the same time were negotiating public discourse recording such
change. This is a good example of how individual memory and societal
discourses interact to form a persons narrative.
According to Mishler (1995), we are continually re-storying our
pasts, and changing the significance of different events, discovering
and altering the connections between events, and repositioning ourselves
Interpersonal and social discourse 121
and other people in our network of relationships. This is a point of

intersection between the individual narrative and social discourse. Much
of this repositioning takes place because of our social relationships, and
because of the changing nature of the discourses (both interpersonal and
societal) around us. Our narratives have key turning points, where we
carry out this repositioning. The turning points are not generally aha
moments (though they can be); they are more usually related to people
and events around us. When narratives and social discourses do not
develop in tandem, then individuals can get left behind in society. As
we shall see in Chapter 10, many older people still function with the
social discourses of their youth, instead of adapting to newer discourses.
Memories belong to the individual at one level, but they are much
wider than that. They are affected by how societal discourses impinge on
individual experience. Individual remembering does not take place in a
social vacuum (Zerubavel, 1997). Other people help us to remember
some things and forget others. There are, according to Zerubavel,
social rules regarding remembering and forgetting, which are termed
mnemonic socialisation. Whenever we enter a new social environment,
whether it is a change of workplace, home or indeed a move to another
country, we acquire new memories. Through this process of mnemonic
socialisation we learn to remember things we never experienced, and to
identify with a collective past. Memories are social and cultural con-
structions. We who were born after World War Two have memories of
that war, obtained through talking to people who lived through the war,
reading books and magazines, seeing films and documentaries, seeing
battlefields in various countries, and seeing memorials both small
memorials to the dead of particular villages and the larger national
memorials that serve not only to honour the dead but also to provide a
cultural memory for the living (Halbwachs, 1992). Social discourses
relate to cultural and social memory, and to both formal and informal
approaches to history (e.g. academic and oral history). Historians who
attempt to describe a past still being lived by participants in that past
may influence the way those participants view their events. There is
limited direct evidence for this proposition, but I have noticed that
there are times, when interviewing ageing war veterans, where the
veteran provides detailed memories about aspects of a battle that
they could not have seen directly, but they have wide collections of
books and films about their war, and it is quite likely (but this does need
formal study) that their memories are influenced by what they have
read and seen. More directly, there is evidence that witnesses to an event
can change their story according to the type of question they are asked
(e.g. Schreiber et al., 2001).
The social process of societal remembering and forgetting is based on

a mechanism relating to our need for such remembering and forgetting.
People are naturally tribal; they belong with other people, and depend
on them for a successful life. In order to be successful in this, people
must take on the behavioural codes and mores of the society in which
they live, and in order to do this memory plays a crucial part.
Memories change because society changes its perceptions of past
events through the media by books, films, newspapers, discussion or
news reporting the whole plethora of information as we receive it.
In order to understand individual memory we have to examine societal
and cultural contexts (Hinchman and Hinchman, 1997).
Discourse impacts on individuals in different ways. There are
accepted norms of society that affect how an individual interprets the
social world. Of course, many people do not accept social norms and so
may be outcast from society (e.g. racists or smokers in Britain), and so
develop or use alternative discourses. This also creates a separation of
groups and possible group conflict (e.g. Tajfel, 1981), which, at best,
generates social debate regarding the benefits of each group, and, at
worst, leads to war. There can be conflicts of memory within a society;
there is often a dispute regarding the nature of societal memory
(mnemonic battles, according to Zerubavel, 1997).
There are many examples of chronological discourse change, which is
related closely to historical interpretation. In Britain in the 1940s we had
the German enemy, which soon after World War Two became the
Russian enemy. Once the Cold War was over, the Russian enemy became
the Islamic enemy, and suddenly the threat of Islamic terrorism is meant
to be all around us. (It is as though there is an Orwellian need for an other
on which to pour out ones hatred, to blame for the ills in society.)
Kamierska (2002) explored the interaction between the social and the
personal, and how past events are important in meaning-making, in
WWII narratives in Polish civilians. World War Two is central to all
Polish family histories. September 1939 was a turning point in the
biography of the nation, and for all Polish people. It was the start of
5 years of occupation by Germans/Russians, followed by 45 years of
Communist rule. An estimated 6 million people died. During the
Communist era the authorities encouraged the people to forget about
many things, for example the pauperisation of landowners.
The history of war trauma throughout the twentieth century provides
another perhaps more relevant illustration of the ways in which
individual memory, narratives and social discourses act together. This
has already been discussed in Chapter 7, so only the key stages are
described here. At the beginning of the century there was some
Interpersonal and social discourse 123
awareness in the scientific community that traumatic neuroses existed,

and that they could have a psychogenic rather than a physical cause.
But this was not widely recognised in western society, as illustrated
by the fact that more than 300 British soldiers were shot for cowardice
or desertion in the face of the enemy in the First World War (Babington,
1983). They were seen as weak individuals who let their comrades
down by refusing to fight. Initially there was a widely held view that
shellshock had a physical origin that individuals with the condition
had experienced damage to the central nervous system. Later in the
war, medical officers and psychologists realised that men were breaking
down for psychological reasons (Rivers, 1922). The different views
shellshock and cowardice were held simultaneously, and applied
differentially to officers (who were more likely to be sent to hospital for
treatment) and men (who were more likely to be court martialled and
imprisoned or shot).
As we have seen, after the First World War traumatic stress was
forgotten, unless you were one of the many thousands of men who were
locked in mental institutions as a result of their war experiences. It was
not until the Second World War that psychological trauma again came to
prominence. In Britain this resulted from the experiences of Dunkirk in
1940, when many men came back from Belgium traumatised, and there
were too few psychiatrists to treat them (Sargant, 1967). In the USA the
realisation came after the invasion of North Africa in 1943, when psy-
chiatric casualties were evacuated to the USA with physical casualties,
and the infantry found itself very short of men. The term battle shock
came to be used widely. They quickly rediscovered the principles of
PIE (proximity, immediacy, expectancy; three principles on which
battlefield psychiatry is still based). In Germany and Russia men
who were traumatised were often shot, showing how different social
constructions were held in different countries.
Contrast these views with those of the latter half of the century. From
the 1960s, when the USA were becoming heavily involved in the
Vietnam war, there has been a growing acceptance that traumatic
breakdown is not a sign of individual weakness, but a genuine illness
brought on by extreme environmental conditions. Acceptance of this view
has accelerated since the introduction of PTSD in 1980 (American
Psychiatric Association, 1980). We have now almost reached the stage
where we expect people to break down after a traumatic event, and
there is something wrong if they do not. In a single century we have
seen views go from one extreme to the other, from the view that break-
down was a capital offence to the view that not to break down is a sign
of a problem.
This demonstrates the importance of the social construction, and also

how peoples individual narratives are formulated within the context of
these social constructions. Traumatised WWI veterans often displayed
hysterical symptoms, with paralysis of the arms or legs, the inability to
speak or psychosomatic blindness. These symptoms were very rare after
the Second World War, and are now almost unknown amongst trauma
victims. Again, this demonstrates the power of social constructions. If a
person is led to believe that they will have one particular kind of symp-
tomatic response rather than another, they are much more likely to have
that response.
That is the societal discourse. Not everyone would agree with it.
During the First World War there were people, such as Rivers at
Craiglockhart, who believed that there were social and familial factors
as to why men broke down in battle (Rivers, 1922). There were many
psychiatrists in the Second World War who helped thousands of men
recover from battle shock. On the other hand, there are still people in the
British Army who appear not to recognise that people can break down
psychologically as a result of battle experience. Social discourses are
never agreed by everyone.
Example: the British Empire

As an example of how social discourses change, we can take the British
Empire, attitudes towards the Empire and the implications of this. This
remains relevant for therapists and researchers treating or studying older
people. Older people will remember the years before the war when the
British Empire was still (fairly) strong, and the early decades after the
war when the countries of empire gained their independence, either
through negotiation or war. Many older people remember the British
Empire as a force for good, where the British exported their knowledge,
understanding and benefaction to the poor ignorant savages of the world
where the cultured brought civilisation to the uncivilised. British people
know these stories they are part of our cultural memory. Younger
people often have a different social discourse: the British Empire was
oppressive, cruel and narrow-minded, and totally failed to recognise that
people in other countries outside of the Empire had civilised societies
they were just different to ours. This applies to individual words. In the
recent past, terms such as Paki and nigger were perfectly acceptable.
They denoted the subjects of the Empire, the untermenschen who were
somehow less human than we white Europeans.
Historians wrote about the Empire in glowing terms how we brought
wealth and civilisation to the world and the social memories of white
Narrative development 125
British people were broadly similar. Now our social discourse of the
Empire has led to changes in the representations of the past through
both history and memory. Historians write of the tragedies which befell
other civilisations when the white man came, and the social memories of
younger people if they include the Empire at all look back negatively,
and see a time of oppression. In this way we can see how memory and
history develop together, how individual social memories of the past are
built on current social representations, and how historians write using
those same social representations.
We can go back 100 years in relation to the British Empire by looking
at the Empire of the USA today. Social representations in the USA now
are broadly similar to those in Britain 100 years ago. Then we thought
we could export our culture to the world; now the USA does the same.
Then we thought we were more advanced than other people; now the
USA thinks the same. Then we used guns to support our position; now
the USA does the same.
Narrative development
As we have seen (Spiro et al., 1994), memories consist of individual
recollections of the past, which may or may not be accurate, which may
or may not be drawn together to form an individual narrative about the
past that enhances, enlightens and supports an individuals personal self-
image. Narratives consist of recollections of individual experience that
has been affected by social and cultural influences such as the media,
family and friends, and also by self-education and development. We
deliberately choose to emphasise certain memories and try to forget
others. This is in order that we have coherence in our lives (e.g. Singer
and Rexhaj, 2006). We try to forget those things in the past which we
perceive as bad and which do not fit our current concepts of the self
(Kihlstrom et al., 2002). Just as remembering is important in under-
standing our narratives, so is forgetting. It is as important to forget as it is
to remember. Just as a novel does not display all the characteristics of the
main protagonists, our sense of self does not incorporate everything we
know about ourself, particularly when it involves projecting that sense of
self outward to family, friends and work colleagues.
This life story, or autobiography, is critical to understanding memory,
and it is conceptualised into a narrative (or narratives). We all have many
thousands of memories, and many ways of interpreting our memories.
We cannot incorporate them all into our life story. We deliberately select
particular elements of our past that fit with the way we want to perceive
and be perceived in society. There are many factors that will impact on
the way memories are selectively remembered, interpreted and changed.

As we have seen, Bartlett (1932) identified many of these factors, includ-
ing the importance of a particular memory, its salience, and the context
in which it is input and recalled. Bartlett focused largely on individual
memory, but these factors are applicable in the wider context of the life
story and societal discourse.
Therefore, in order to understand memory, we need to go beyond the
discipline of psychology and draw on the works of sociologists, political
scientists, historians, novelists and people in the media people who
record societal memories in different ways. Only then can we understand
how and why people have particular memory networks or narratives.
Narrative development and trauma

Traumatised people lose the coherence of their life narratives; traumatic
events fundamentally alter the way people think, their views about their
own strengths and weaknesses, how they believe others should act and
the nature of the world generally. It is as though the written words of
their lives are jumbled up and made meaningless. Recovery from trauma
means making sense of it all again, learning to understand the world as it
is in the light of the traumatic event, incorporating the new trauma-
related information into ones own narratives. Narrative development
can occur in a number of ways, some of which are illustrated in later
chapters. Narratives can be constructed through discussion with others,
thinking it through for oneself, writing down ones interpretation of the
traumatic event, drawing or painting, or seeing a clinical psychologist or
other therapist. Some people do not succeed in developing narratives
about their trauma; they may use avoidant strategies (as discussed in
Chapter 5), and live symptom-free lives. Others may be unable to make
sense and use alcohol or other drugs to deal with their troubled memor-
ies. Everyone is different in the way they deal with what happened to
them, and it is not the role of anyone to suggest that one way is better
than another. It depends on the person. Here we can see that there are
universal and cultural aspects of how people deal with their memories. If
a therapist is going to be able to help someone, he/she not only needs a
good knowledge of the universal aspects of how people respond to
traumatic events; that therapist must also take into account the cultural
aspects the social and cultural reasons why people develop the narra-
tives that they have in any given culture and at a particular time point.
9 Illustrating narrative as a scientific technique:
the role of social support
One of the problems with narrative is its psychological application in

a practical manner. Describing narratives scientifically is a difficult task.
A story, however presented, consists of a complex set of rules and
statements, which do not necessarily lend themselves to a straightforward
analysis, particularly if the analysis must be inked to other variables, such
as scores on a measure of PTSD.
The narrative approach, as we have seen, was largely developed in the
social sciences, particularly sociology, being brought over to psychology
in a number of ways by a variety of people. While this has added
enormously to psychological understanding, there have been, and
remain, issues regarding the scientific use of narrative approaches in
psychology, approaches that are acceptable to the broader group of
psychologists, many of whom are embedded in the quantitative trad-
ition. For many quantitative psychologists, qualitative approaches are
still anathema, so there is a need to demonstrate the utility of such
approaches. One example is presented here. This chapter is based on
the PhD work of Dr Karen Burnell, whom I jointly supervised with Peter
Coleman.
As already discussed, narrative is key to our understanding of our
lives, the ways in which we think and the ways in which we interact with
other people. It is in our nature to (it is unavoidable to) talk to each other
in story form, to explore our identity and to share experiences. As shown
in Chapter 8, narrative is a way of making meaning of our experiences so
that we are able to grow from them. Karen Burnells work (Burnell et al.,
2006; in press) focused on the role of social support in the reconciliation
of traumatic war experiences throughout life. My previous research has
recognised the importance of social support as one of the most effective
ways of dealing with traumatic life events (Hunt and Robbins, 2001b).
Previous research has also indicated the importance of using narrative to
develop a coherent story that enables survivors of traumatic experiences
to come to terms with their experiences, and also to experience post-
traumatic growth.
127
128 Illustrating narrative as a scientific technique: the role of social support
Social support is a vital element in reconciliation after a traumatic

event, but reconciliation is often considered to be the result of the
alleviation of PTSD symptoms. This research has indicated a more
complex picture, with PTSD providing, at best, only a crude approxi-
mation to war trauma. Reconciliation, in the narrative context discussed
here, is the integration of traumatic events into the overall life story,
removing (or at least reducing) the threat of traumatic memories, and
thereby increasing autobiographical coherence. As already discussed, we
are in a continual state of creating our life story, so an appropriate
approach to understanding how traumatic memories are reconciled is
to study how war veterans integrate their experiences into their life story;
that is, we need to study the meaning-making process that lies at the
heart of narrative and narrative development.
Assuming that social support is an important aspect of reconciliation,
how can social support resources aid or hinder this reconciliation?
Drawing on a sample of war veterans, this research analysed the narra-
tive form (the level of coherence) and the narrative content (in this case
social support) resulting from semi-structured interviews with war vet-
erans who were drawn from across all stages of the lifespan and across
different stages of narrative development. If we can demonstrate the
processes by which people develop effective narratives through social
support, we may be able to encourage the resources to enable these
narratives to be developed more quickly and more effectively. Through
developing our understanding of the cognitive, social and physical
resources that are important for effective narrative development, we
may be able to enhance their use, particularly as such resources may
be lost in later life.
The experience of trauma disrupts the creation of the life story, creat-
ing an incoherent, disorganised and fragmented narrative. This special
nature of traumatic memory makes integration problematic for many
people, but integration it is argued is vital for coherence and, in turn,
reconciliation.
Traumatic memory is made of up two different types of memory.
First, individuals who have been negatively affected by trauma may have
very vivid and clear memories of the event. Second, the narrative
account of the event is fragmented, disorganised and contains gaps.
The importance of narrative coherence is understood within thera-
peutic circles. For instance, in a study conducted with female rape
survivors, Zoellner et al. (2002) found that ease of reading personal
trauma narratives of rape decreased with increasing post-traumatic
symptoms. Thus, the more symptoms experienced by an individual,
the harder the narrative was to read due to its incoherent and fragmented
The narrative coherence model 129
nature. Additionally, traumatic memories are initially recalled as dissoci-

ated mental images of sensory and affective elements. It is only over time
that the trauma narrative emerges as an explicit and integrated personal
narrative, where the individual can make sense of their experiences and
place them in the past. Many veterans will tell of their experiences, and
recount the smells of the battlefield, sensations that were originally
fragmented, or they will explain how they can now make sense of the
reasons why something happened as it did and they know now that they
could not have prevented it.
Narrative coherence
What makes a story coherent? Many people have highlighted the signifi-
cance of coherence as a vital characteristic of a good story, both
theoretically and empirically. Examples range from students of literature
to psychologists. In all fields, a good story is a good story. Linde (1993)
defines narrative coherence as a property of the text, which represents
the relationship between parts of the text and, consequently, the overall
text. Coleman (1999) takes this further by suggesting that coherence
comprises subjective truths, interpretations, emotions, unity/integration,
purpose and meaning as characteristics. Coherence is a social obligation
that must be fulfilled in order for the participants to appear as competent
members of their culture. The necessity for an audience to understand
the story has implications for identity, problem solving and sharing.
In the case of war trauma, veterans must have an audience to provide
support for the processing of traumatic memories, which leads to
reconciliation.
The narrative coherence model

Despite past research on narrative coherence, it has not yet been fully
operationalised, which has made the use of narrative coherence method-
ology problematic. A framework methodology was established based on
the narrative content (what veterans talk about; in the present case social
support) and narrative form (the way in which the narrative is expressed;
narrative coherence) (Burnell et al., 2007). This two-level approach to
narrative analysis allows us to address the research question regarding
the potential relationships between social support and narrative coher-
ence as reconciliation of traumatic war memories.
The model of narrative coherence is based on the work of Baerger and
McAdams (1999) and McAdams (2001, 2006), who formulated the
Table 1 Description of narrative coherence indices
Index Description
Orientation The narrative introduces the main characters and locates the story in
a specific temporal, social and personal context. The narrative describes
the habitual circumstances that serve as the parameters for the action
of the story.
Structure The narrative displays the structural elements of an episode system. Thus,
the narrative has at least one of the following: an initiating event; an
internal response to this event (e.g. a goal, a plan, thought, feeling); an
attempt (e.g. to reach a goal, carry out a plan, remedy a crisis, resolve
a state of emotional disequilibrium); and a consequence. These elements
are presented in a causally and temporally logical way (e.g. the initiating
event precedes the response, which in turn precedes the attempt).
Affect The narrative reveals something about the narrator, or about what the
events described therein mean to the narrator; the narrative makes an
evaluative point. The narrative uses emotion in order to make this
evaluative point, employing explicit statements of feeling in order to
create an affective tone or signify emotional meaning. Thus, the narrative
uses tension, drama, humour or pathos to communicate and emphasise
the evaluative point.
Integration The narrative communicates information in an integrated manner,
expressing the meaning of the experiences described within the context
of the larger story. Discrepancies, contradictions and inconsistencies are
eventually resolved, and the various narrative elements are synthesised
into a unified life story. Although complexity, ambiguity and
differentiation may be used to indicate suspense, conflict or growth, the
narrative ultimately reconciles these disparate story elements with one
another.
Note: This is an adapted version of the original table presented by Baerger and McAdams
(1999).
only coding structure for quantitatively measuring coherence to include

orientation, structure, affect and integration criteria (see Table 1).
Baerger and McAdamss orientation and structure indices are based
on the work of Stein and Glenn (1979), who argue that a narrative must
have specific storytelling characteristics, such as orientation to main
characters and temporal information, and the presence of an event
an internal response, a reaction, a consequence and resolution.
A sequential story is not enough to render it coherent. According to
Singer and Rexhaj (2006), a story must have a point, an emotional
evaluation and a moral lesson. Also, Baerger and McAdamss (1999)
affect index posits that narratives exist to convey emotionally significant
information. In this way, a good story will be organised around a high
The narrative coherence model 131
point when the action or emotion (either positive or negative) will be at

its most intense. After relating this position, the emotional content is
either resolved or diffused by the narrator.
Finally, the integration index refers to the integration of experiences
into an overall life story, and is seen as an important element of coher-
ence. Many psychologists have written on the importance of integration
in later life.
An evaluation of Baerger and McAdamss (1999) operationalisation of
narrative coherence draws parallels with other concepts of narrative
coherence. Habermas and Blucks (2000) work on coherence as a devel-
opmental task highlights the importance of global coherence within the
personal narrative (i.e. a narrative understanding that incorporates all or
most elements of a persons memory cohesion and identity). Global
coherence is split into categories of temporal, biographical, causal and
thematic coherence. Temporal, biographical and causal coherence com-
plement the concept of structure as an element of coherence. Causal
coherence also extends to coherence of personality traits, attitudes,
etc., to provide an explanation for contradictions within the narrative.
Thematic coherence is similar to the concept of integration because
it suggests that coherence must be based on a credible theme which
unites various experiences throughout life into one life story. Thus, the
concepts of linked events and chronological order are of importance in
assessing coherence.
Whilst global coherence is identified as being important within the per-
sonal narrative, this type of coherence is applicable to the local coherence
(within sections) of the narrative; that is, these principles apply if,
for instance, a person is attempting to make sense of their war experiences.
Habermas and Bluck do not refer explicitly to emotional coherence,
but they argue that consistent affect is an important element of the
narrative. Androutsopoulou et al. (2004) support the work of Baerger
and McAdams. In their study, the authors assessed the types of coher-
ence seen during consecutive sessions of narrative therapy. Although
only focusing on local coherence, they placed importance on compre-
hensibility and evoking empathy at both the manifest and latent levels of
the narrative. In their criteria, comprehensibility included the related-
ness of events and explanation of contradictions, which echoes the
elements of integration and thematic coherence cited above. Evoking
empathy referred to acknowledging and responding to the needs of the
audience and being in touch with emotions, which was defined as not
venting or ignoring emotions, but acknowledging and processing them
as part of the overall narrative. This component is therefore in line with
the affective element of Baerger and McAdams.
Habermas and Bluck also introduce the concept of integration, but

they argue that it is in adolescence that we begin to integrate the different
experiences of our lives as part of the overall coherent life story. This
conforms with work relating to the importance of adolescence as being
the period during which people establish their identity independently
from their parents. In line with previous research, integration is import-
ant when communicating our experiences to others. According to Linde
(1993), there can be many explanations within a story as long as they do
not contradict one another. This is important from a therapeutic point of
view, as it demonstrates the potential complexity of a coherent narrative,
a point that should be remembered by individuals involved in helping
people to make sense of their traumatic experiences.
Development of the narrative coherence model

The narrative coherence model presented here is a synthesis of previous
research. Habermas and Bluck do not provide adequate depth of infor-
mation regarding narrative coherence for their model to be applicable.
Also, the criteria of Androutsopoulou et al. are not sufficient. Finally,
Baerger and McAdamss criteria do not focus on reconciliation, which is
critical to the current study, though it is used as a basis for the current
model.
Participants
The model was tested using samples of British war veterans. It was first
applied to narratives of ten Second World War veterans. After this initial
test, in which it did not need to be modified, it was applied to the
narratives of twelve post-war veterans of wars and conflicts, including
Suez, Korea, Aden, Cyprus, Northern Ireland, Falklands (Malvinas),
the Gulf and Iraq. The use of different war veteran groups demonstrates
the applicability of the model to different groups.
Transcripts
The interviews were transcribed in full, including non-verbal utterances
(such as ah, oh, er). Brief intervals between utterances are marked
with . . . and longer intervals marked in seconds, e.g. [3]. All quota-
tions are anonymous, but each participant is identified by his/her initials,
and quotations note the line number(s) of the transcript.
For further details of the analysis and coding, please refer to Burnell
et al. (2007).
Orientation and structure 133
Table 2 The narrative coherence model
Type of coherence Coding criteria
Basic storytelling Orientation O1 Introduction of main characters

principles and (scene setting)
structure O2 Temporal, social, historical and personal
context
S3a Structural elements of an episodic system
presented with causal and temporal coherence
(does not include contradictions). Structural
elements include an initiating event, an internal
response, an attempt and a consequence
S3b Explicit recognition of temporal coherence,
e.g. Ive jumped the gun/where was I ?
Explicit recognition of storytelling
Emotional and Affect A4 Past or present emotional evaluation of what
thematic described events mean to the narrator
evaluation of communicated through explicit statements
lived experience of emotion
A5 Consistency of verbal and non-verbal
elements within a meaning unit
Integration (f) I6 Meaning of events/experiences is expressed
within the context of the larger story. This
includes a coherent theme linking all the events
(theme may be explicit and/or implicit).
(g) I7 Contradictions between events or the
narrators personality traits or values,
emotional evaluation or changes in attitudes
are acknowledged and explained in a causally
coherent manner.
(h) I8 Presence of fragmentation of the narrative
defined as long pauses and broken speech,
and unfinished sentences. Also, defined as
incongruent information within the context of
the larger narrative. (Unless otherwise stated,
the narrative is fluid.)
Coding
Table 2 describes the proposed coding criteria.
Orientation and structure

The orientation and structure criteria (O1/O2, S3a, but not S3b) relate
to local coherence and were taken from the work of Baerger and
McAdams (1999) in order to recognise basic storytelling principles
within the narrative. Emphasis on specific types of coherence (temporal

and causal), which added depth and detail to the analysis, was influenced
by Habermas and Bluck (2000). Criterion S3b was an original addition
to the analysis due to the Second World War veterans explicit awareness
of temporal coherence found in the interviews, such as it broke part of
the hinge of the ramp [2] ah [4] but Ive jumped a gun [IH].
These principles must be identified within the analysis because, with-
out them, the audience cannot be captured or entertained, and all narra-
tives are created at least in part for an audience. This social element is vital
if veterans are to have a supportive environment in which to process their
memories. Whilst the content of stories may differ, the basic elements that
constitute a story should not. For instance, the following quote from an
Iraq veteran contains this story structure; it has an event, an internal
response, an action, a consequence and resolution.
so . . . shortly after that . . . the pressures that caused me to get divorced . . . [KB:
right] . . . and then . . . having to start life again with er . . . basically a back
pack . . . like being in the jungle as I call it . . . and trying to get onto the ladder
again . . . which was very difficult . . . and then . . . I got myself together and . . .
I went to work as a civilian on the Army camps . . . cos obviously being . . . and
I was attached to the Army aircorps . . . for 2 years . . . up in [town] . . . and being
an ex-regular . . . and no . . . chefs up there . . . I used to go on helicopters . . .
down training in down in . . . [town] . . . with all the paras . . . I even had my own
uniform . . . enjoyed the drops . . . really . . . well . . . and I lasted over 2 years . . .
and erm . . . thought . . . one of the guys says why dont you get back to uniform . . .
so I thought . . . dont want to go back into regular . . . so . . . join the TA . . .
so I went through all the fitness again . . . passed it . . . at the age of . . . 30 odd . . .
[PH L23:34]
Affect
Affect and integration are vital aspects of narrative coherence because
they highlight complexities of the narrative. If stories are perceived as
being too simple, they cannot realistically reflect lived experience. Emo-
tional evaluation also reflects the ability to express congruent emotion of
traumatic events, which is especially indicative of reconciliation.
The affect criterion (A4) was influenced by Baerger and McAdams
(1999), which captures the emotional evaluation contained within
the narrative. A4 is only applied to explicit statements of emotion.
A5 represents Androutsopoulou et al.s concern with unreconciled
emotion displayed either verbally or non-verbally. From initial applica-
tion of these criteria to the interviews, a number of emotional
Integration 135
inconsistencies within the narratives were found and the inclusion of

criterion A5 became necessary. Both affect criteria are applied at the
local level. Taken together, these two affect criteria allow for a holistic
evaluation of the emotional content of the narrative.
An example of consistent affect and emotional evaluation came from a
Second World War veteran. In this quotation, he talked about taking the
salute from currently serving troops on a recent Remembrance Day
parade in Canada. The meaning of the event is evaluated and communi-
cated, and verbal and non-verbal affect is consistent:
. . . the Burma Veterans [1] those who could were asked to join in the erm . . . and
also Hong Kong veterans . . . because that was the other group of veterans . . . the
ones who were imprisoned in Hong Kong [1] erm . . . were asked to join in
the march so we marched around the . . . and yeah you felt good there . . . and the
Governor General took [1] the salute and you could even straighten your
shoulders and [puffs out chest] [laughs] and it felt [2] it felt good [1] but
then . . . er [1] after wed done that . . . er . . . which wasnt a very long march
thank goodness . . . but erm . . . they put us all on the side of the road . . . and then
they had all the Canadian [tearful] present day troops [tearful] march past and
salute us [4] that made you feel good too [5] [DS]
Integration
Integration represents the last element of narrative coherence, and is
split into three levels: the presence of a uniting theme (Criterion I6),
explanation or absence of contradictions (Criterion I7), and absence of
fragmentation and disorganisation (Criterion I8).
Criterion I6 is a necessary criterion as it relates to the presence of a
theme within the narrative, which brings elements of the narrative
together in a meaningful way, and advances lived experience in a way
that could provide a meaningful message for future generations. From
the perspective of reconciled war trauma, a theme is necessary because it
gives meaning to events that challenge the coherence of the life story.
Criterion I6 represents global coherence, and provides a means of deter-
mining the extent to which war experiences have been integrated into the
life story.
This criterion was present across age groups and cohorts as demon-
strated by one Falklands (Malvinas) War veteran. Aged 40 years at
the time of the study, this veteran explained how his experience in
the Falklands had a positive impact on the way he felt about everyday
life, and in this sense the experience is integrated as a beneficial
experience. There is emotional evaluation in this excerpt. However, it
falls into the I6 category rather than the A4 category because he indi-
cates how his Falklands War experience has affected subsequent percep-
tions of life:
I often say [2] I say to people that know . . . and who would have some kind of
understanding having been in the . . . in similar circumstances [2] that it was the
best and the worst time of my life [5] erm and I say that because [3] the worst
time because of [3] people getting killed erm [2] erm . . . things that you see [1]
but the best of times because erm . . . life is so much simpler [5] it really doesnt
matter whether you [1] whether youre all overdrawn thousands of pounds . . .
what kind of car you drive [2] erm [2] whether youre married . . . thats different . . .
no [1] but material things and the [1] minutiae of sort of daily life . . . it
doesnt . . . it doesnt even come into it [1] its life or death . . . and that
makes life very simple . . . its very pure [3] and each day is [1] fantastic . . .
you know . . . you can wake up and it can be absolutely chucking it down [1]
and er [3] you know you feel it may be cold [1] but . . . you think . . . well . . .
you know . . . its another day . . . everyone is around me . . . and [3] and
you have that comradeship [3] but ah [1] it made [3] life that much
sweeter . . . [DW]
Some veterans integrated their narrative with a theme that is negative

and maladaptive in nature. For instance, for one Iraq veteran, who was
undertaking therapy for PTSD at the time of the study, the overall theme
was but . . . every day is a battle . . . [PH]. Kilshaw (2004) studied the
narratives of Gulf War syndrome (GWS) and found that poor health was
associated with narratives that revolved around the perpetuation and
terminal nature of GWS, which was central to the life story of Gulf
War veterans. Consequently, for the current criteria, the integrating
theme was required to be positive in nature. Reconciliation is not making
a negative narrative central to the life story, but rather integrating it as
one coherent chapter of the life story. This way, and in accordance with
Brewins theory of VAM/SAM, the memory loses its threatening and
unconscious nature, can be recalled explicitly as an important and
perhaps emotional memory, but also relates to other experiences that
have occurred in ones life.
Analysis of contradictions within the narrative (Criterion I7), at both
the global and local levels, was included in order to assess the consist-
ency of integration within the narrative. If there is contradiction within
the narrative, traumatic war memories have not been fully integrated and
therefore remain unreconciled. Causal coherence was assessed to indi-
cate the completeness of the story, including logical and functional
contradictions that may make the narrative incoherent. The following
example demonstrates contradiction between the personal beliefs of a
WWII veteran at two points within his narrative. The reason for, and
Integration 137
feelings towards, serving in the RAF are incongruous, but this is not
explained or recognised by the veteran in the narrative, resulting in
contradictory personal beliefs:
. . . yeah . . . I enjoyed flying . . . it never bothered me . . . its a job . . . just a job . . .
work which I was being paid for . . . ah . . . it wasnt my main love . . . my main
love was football . . . ah [2] but the RAF hadnt paid me to play football [1]
[laughs] [1] [WS]
. . . I joined up to fly for here . . . from Britain . . . to defend my Mum . . . and
Dad . . . thats . . . the reason behind my joining up [1] I thought if peoples going
to drop bombs on Mum . . . Im going to . . . do my damnedest for them . . . and
thats my simple thinking in 1940 . . . [WS]
Finally, Criterion I8, which identifies fragmentation and disorganisation
within the narrative, was included in order to combine findings from
clinical trauma narrative studies within the narrative analysis. This cri-
terion represents symptoms of unreconciled trauma. At the local level,
veterans were perceived as having a fragmented narrative if there was
broken speech, unfinished sentences and long pauses, or if it contained
incongruent, but not contradictory, material. At the global level, I8 was
also defined as incongruent (but not contradictory) information within
the context of the larger narrative.
In order to be considered a coherent narrative, all criteria must be
present within the narrative; no one criterion was perceived as being more
important than another. While this may seem contentious, all elements
of the narrative must be present in order for it to be classified as a
narrative. Future research can identify which elements are relatively more
important for a coherent narrative. Here, if a criterion was absent, the
narrative would be considered incoherent. Without the narrative orienta-
tion and structure, the veteran cannot capture a supportive audience
to aid reconciliation, and without this audience, consistent emotional
evaluation and integration are more difficult to achieve. As noted earlier,
after applying the model to narratives of Second World War veterans,
all criteria within the model were successfully applied to the post-war
veterans narratives without needing to be adapted or supplemented
with additional criteria. This demonstrates the models transferability
and effectiveness in assessing narrative coherence across age and cohort.
The model was able to differentiate between coherent and incoherent
narratives; both coherent and incoherent narratives were present in the
sample. The differentiation of coherence linked to the thematic analysis
of narrative content concerning the presence or absence of traumatic
war memories. The overall pattern in the data indicated that narrative
content of coherent narratives explicitly stated that there was no trauma,
whereas the content of incoherent narratives contained themes of
battling with traumatic memories, or struggling to come to terms

with traumatic experiences. The study does not enable us to test this
empirically as there were no measures used to measure PTSD or war
trauma the focus was on developing the narrative coherence model.
Case studies
In the broader context of the data analysis, narrative coherence was
presented within qualitative case studies for each participant. These case
studies included thematic analysis of perceptions and nature of war
experience, and analysis of experiences of social support (as well as the
presence of traumatic memories). The combination of these two levels of
analysis allows for the exploration of potential relationships between the
types of social support that are associated with narrative coherence. This
potential causality has interesting therapeutic implications.
By interviewing veterans of different wars and age groups, knowledge
about the ways in which traumatic war memories are reconciled at
different stages in life, and by different war cohorts, can be developed.
Also, the generic model can be applied to the reconciliation of traumatic
memories resulting from other traumatic experiences, not only war.
Conclusions and implications

The ability to understand the ways in which social support aids and
hinders the reconciliation of traumatic war memories is of particular
concern for theorists and therapists, because the lack of narrative coher-
ence has implications for the wellbeing of the storyteller. This does not
just apply to trauma; it applies across a range of mental disturbances,
relating to anxiety and depression, and a range of other issues concerned
with an inability to cope effectively in the world, whether in a generic
sense (e.g. generalised anxiety or depression) or in relation to some
specific target (e.g. eating disorders). Indeed, many such problems can
be seen as a failure to hold and express a coherent narrative.
Another issue arising out of the current study is that of whether, and
how, veterans manage to reconcile their war experiences before critical
resources, such as cognitive ability, social networks and physical health,
become depleted since these resources are vital for processing experi-
ences into a coherent narrative. This will be explored in more detail in
Chapter 10.
The narrative method described emphasises the importance of narra-
tive devices in producing a coherent and reconciled narrative. This is
also related to the dual representation theories presented by numerous
Conclusions and implications 139
authors (e.g. van der Kolk and Fisler, 1995; Brewin et al., 1996), with
narrative development transferring sensory-activated memories to
verbal-activated memories, thus increasing voluntary control over the
memories (similar to Janets description of trauma resolution consisting
of turning trauma memories into narrative memories). This approach
brings together Bruners distinct narrative and paradigmatic cognitive
ways of knowing within one research approach narrative affects cogni-
tion, and vice versa (Bruner, 1986).
There are several benefits to this approach. The main one is that it is a
systematic procedure applied to interview transcripts that appear to
predict the effectiveness of narrative development in the light of social
support. Much more work needs to be carried out in this area, but it is a
substantive framework for further research, both with war veterans and
other traumatised groups, and with both the role of social support and
other key variables. In the end, this should help to provide more effective
ways to facilitate reconciliation than can be carried out using the natural
process of meaning-making. Equally, it can contribute to an initial
assessment of veterans in therapy sessions, which can provide knowledge
of the veterans social support networks, and aspects of the narrative
coherence that are absent.
10 Ageing, trauma and memory
I used to think what landmines have I tripped over now . . . Theres nothing
to be seen but if you tread on the bugger it goes up.
Normandy veteran, 1994
This chapter examines the very long-term effects of war. Central to this
is a study I carried out a few years ago with WWII veterans (Hunt, 1997;
Hunt and Robbins, 2001a, b). It addresses the extent and nature of war-
related distress experienced by the veteran population, and the factors
that predict such distress. The effects of traumatic stress on the older
population are exacerbated by developmental changes, which in them-
selves are stressors. These include diminished sensory capacity, reduced
mobility, frailty, reduced income and social status due to retirement, loss
of friends and subsequent isolation, ill health and reduced self-care
(Cook, 2001), though many people do not experience significant decline
in their cognitive abilities, and many develop special expertises. Major
physical and mental decline often does not occur until very advanced age
(Coleman, 1999).
War has very long-term or permanent effects (Hunt, 1997; Spiro et al.,
1994; Bramsen and van der Ploeg, 1999), though some of the symptoms
may be less marked than in younger people (Fontana and Rosenheck,
1998). For instance, dissociation may be less persistent over time
(Yehuda et al., 1995). There may also be complications involving
coexistent syndromes, or different patterns of symptoms; for instance,
Goenjian et al. (1994), in a group of earthquake survivors with PTSD,
found higher arousal levels and lower levels of intrusion, though the
overall PTSD severity was similar. There is also some evidence of older
adults having protective mediating variables, for example appraisals of
the desirable and undesirable effects of trauma respectively decreasing
and increasing the relationship between combat exposure and PTSD
(Aldwin et al., 1994).
People who experience war often claim that the memories they have
when they get old are as strong as they ever were, or even that they
140
Ageing, trauma and memory 141
become stronger. This links with Butlers (1963) notion of the life
review. As we age we look back on our lives, particularly the key areas,
and attempt to make sense of it, i.e. we actively work on the narrative of
our lives. Inevitably, we focus on the more difficult areas, which, for
many old people in the UK now, are the war years. This links to
Eriksons (1982) need for personal integration as part of normal ageing.
Many people still have problems many decades after their war experi-
ences, it being estimated that in the 1990s up to 10% of the older
population may still have been suffering from earlier (mainly war-
related) traumatic experience (Hunt et al., 1997). What we dont know
is whether treatment at the time of the war would have been of any long-
term benefit, or whether these problems would have continued to
emerge as the veterans got older.
Various treatment models have been developed or adapted for
older veterans. For instance, Robbins (1997) developed a treatment
model based on his experiences treating Second World War veterans.
Robbins recognised the emotional power of the traumatic memories,
and their potential to overwhelm the therapist. The framework for
treatment was developed to enable the therapist to cope with these
emotions and his/her own responses to them. The treatment consists
of four phases. The first phase, disclosure of events, is carried out in
two stages getting an overall picture of what happened, followed by a
detailed review of events to clarify any confusion and identify dysfunc-
tional cognitions and the emotions associated with them. The second
phase is an exploration of the cognitions and emotions associated with
the events. The therapist and the individual work together to identify
specific key issues or themes, and the link between past events and
current thoughts and feelings is established. The third stage is behav-
ioural change, working with the individual to establish ways to enable
change and improved coping. This might involve discussing problems
with relatives or learning anxiety management techniques. The fourth
and final stage critical to the process is termination. This is partly
about the end of treatment, but is also about the individual taking
responsibility for future planning. Issues around loss, future contact
and follow-up are discussed and agreed. This treatment model is
not dissimilar to other models, but takes into account the special
circumstances of traumatised people, and also the impact of ageing.
As Robbins (1997) notes, the impact of ageing and loss of work
status (see also Ehrlich, 1988) can lead to feelings of helplessness,
which is reinforced by infirmity. Such helplessness, for those who
were ex-POWs, can reawaken emotions associated with captivity (see
also Elder and Clipp, 1989).
WWII veterans, memory and coping

Data were collected from over a thousand veterans using a variety of
methods, including questionnaires, depth interviews and obtaining
narratives of battle in various forms, e.g. unpublished journals and
published books. During this time I have also collected material such
as photographs and mementoes. All are relevant to the overall narratives
experienced by British WWII veterans in the late twentieth century
(Hunt, 1997; Hunt and Robbins, 2001a, b).
Questionnaire
The questionnaire consisted of several sections: biographical informa-
tion, which asked questions regarding history of illness and details of war
service; combat experience, which was developed to provide a valid and
easily completed measure of the amount and severity of combat an
individual has experienced; the Impact of Event Scale (IES) (Horowitz
et al., 1979); the General Health Questionnaire (GHQ) (Goldberg,
1978); and several open-ended questions.
Participants
There were 731 veterans from the Second World War (n 657, 90%)
and the Korean War (n 22, 3%), with n 52 (7%) taking part in both
wars, with a mean age of 72.4 years (range 5989, sd 4.2) when the
study was conducted. Nearly all (97%) were retired. They represented
the range of armed forces: 53% had served in the British Army, 11% in
the RAF, 27% in the Royal Navy, and 6% in the Royal Marines. Veterans
were asked to provide their highest rank. This was recoded in three
categories: officers (n 125, 17%), NCOs (n 346, 47%) and Privates
(n 234, 32%). Many of the sample were ex-POWs (n 105, 14%).
Findings
Nineteen per cent (139 individuals) scored above the cut-off points on
both the GHQ and the IES, indicating possible war-related psychiatric
caseness. No claim is made regarding the PTSD status of these individ-
uals, as the measures are self-reported ones. While there are problems
with the interpretation of self-report measures, these findings are inter-
esting simply because they show that people many decades after their
war experiences still have psychological symptoms relating to those
experiences.
Open-ended questions 143
Officers experienced less psychological distress than NCOs and

Privates, and retired veterans experienced higher distress than those still
working (though the number of non-retired veterans was small (22)).
Veterans with war-related illnesses have higher levels of intrusion and
GHQ, perhaps indicating that those maimed by the war think about it
more often and are now experiencing more physical problems, perhaps
due to the ageing process.
Importantly, combat experience was only slightly predictive of
psychological distress decades later, even for those with particularly
traumatic experiences, such as prisoners of war of the Japanese. This
demonstrates the limited relevance of the actual traumatic experience
after many years have passed. The way someone thinks about their
experiences, rather than the experiences themselves, seems to be more
predictive of longer-term problems. It was not clear whether veterans
had war-related problems ever since the war, or whether they emerged
only in old age or after retirement. Retirement is a life event which is
potentially traumatic but which may provide more free time to think
about the past, about the more important times in ones life, about a
need to review ones life (Butler, 1963) and about the general effects
of ageing.
Open-ended questions
The veterans were asked general questions about what they found inter-
esting and disturbing about the war. The most disturbing aspects of
their experience were: battle/combat experience, physical conditions,
the effects on others and the government.
It is perhaps inevitable that many of the strongest memories veterans
have is of battle experience. For many, the horror of such experience was
still strong after 50 years, and it is the type of memory that is most likely
to lead to psychological difficulties on the part of the veteran, though it
should be borne in mind that the strength of the memory may not
correlate closely with the traumatic nature of the original experienced
event. The next most common response involved the physical conditions
under which the men lived, both during battle and at other times during
the war. The cramped conditions of ships, the weather and the poor
food all were mentioned on numerous occasions. British Second World
War veterans suffered these conditions for up to 6 years. Apart from
worrying about themselves, veterans would consider the worries they
had about their loved ones at home parents, wives and children whom
they knew to be suffering through German air attack or food shortages.
Family separation has received little attention in the post-war years,
along with the consequences such separations might have on the longer
term functioning of such families. This was perhaps particularly the case for
those married with young children. It is also only recently that research has
considered the effects of war experience on those too young to have been
involved in the fighting, or the women left at home (Waugh, 1997).
Another common response was the veterans attitudes towards the
government. There was bitterness towards the present-day government
that stems from a sense of unfairness at the governments refusal to assist
ageing veterans. People who had spent their early years defending the
country were now getting a poor deal regarding the health service and
pensions. Their present problems may be exacerbated by this bitterness.
These issues are similar to those arising for current veterans of Iraq and
Afghanistan, who have similar problems relating to obtaining help for
their problems. This illustrates the importance of accounting for the
relevant socio-cultural factors.
Many veterans thought that the novelty of their experiences was the
most interesting memory they had of the war, particularly meeting new
people both from the same culture and from cultures around the world,
and seeing new places. The majority of this generation would not have
had the opportunity to travel as many of these veterans did. Most would
never have been abroad before, and would not have done so had the war
not occurred. With regard to meeting people of different social classes in
their own culture, this had a major impact on the changing social
attitudes of the wartime generation, an impact that would last a lifetime
and change the nature of the post-war country.
The next major response to the question concerned comradeship.
While none chose to define what they meant by comradeship, it was
clearly important to very many veterans. It was concerned with the unity
of people (whether battle unit or nation), and peoples reliance on one
another. Veterans felt that comradeship has gone from modern society.
This may also have had an impact on their present psychological state.
The interviews
Twenty-five respondents were interviewed. The first ten were Normandy
veterans. The rest included veterans who were ex-POWs and others
who had experienced high levels of combat or other war experiences,
and who either scored very high or very low on the self-reported symp-
tom scales.
The veterans were asked in detail about their memories (the ways they
have changed, what was most important, intrusive recollections, etc.),
and also about the ways in which they coped with their experiences,
Intrusive recollections and other memories 145
including social support, both at the time and later, and about any
effects they felt they still had.
Findings
A large number of themes emerged, only a sample of which is included
here. The veterans experienced three main types of memory, of which the
first two are particularly important for the general argument of the book:
(1) Intrusive recollections. These are implicit, uncontrolled and associated
with strong emotion and/or perceptual elements, the memories
usually associated with traumatic stress.
(2) Consummate memories. These are detailed, likely to be confabulated,
and may in the past have been intrusive recollections. The veteran
has learned to deal with the emotions attached to the memory and
developed a narrative. He may still experience anger or sadness
when recalling the event, but these emotions are under control.
These are important memories when dealing with distant retro-
spective trauma, as they indicate which memories were problematic
to the person.
(3) Ordinary decayed memories. These are memories that were never trau-
matic, which the individual remembers in the ordinary kind of way,
and which are subject to the normal processes of decay. The individual
is likely to remember aspects of an event, but not with emotion.
As these memories are retrospective of a time many decades prior to
their recall, no attempt was made to verify them through other means
and no comment is made regarding their accuracy. By definition, some
of the memories will have been adapted and changed; consummate
memories are likely to consist of elements of what really happened
and elements that the veteran has incorporated in order to make
sense of the memory. There is also the issue of the audience. Veterans
are likely to tell different stories to a researcher (me) than the stories they
tell to each other or to their families. The audience for the narrative
affects the narrative that is told, as all narratives depend on there being
an audience.
Intrusive recollections and other memories

I dont think you ever forget anything. I am convinced of that. Its just that the bloody
thing wont bow down . . . if something triggers them off.
Wartime intrusive memories intruded on some veterans everyday life;
they assume such importance that they are unable to stop thinking about
particular memories. There is a build-up over time and the memories

eventually intrude into consciousness:
You bottle it up. Then of course you bust every now and then . . . its a safety valve
really. I bottle it up for so long then the lot comes out. Its a good thing I think really.
But all that stems from the war, from the war experiences.
Though their effects may be temporary:
Occasionally something will happen and, oh dear, that reminds me of so and so and
then I think I go a bit moody for a while. My daughter says Hes got one on him again.
But it blows over. It blows over.
What kinds of memory are potentially traumatic?

Veterans experienced different kinds of traumatic memory, as shown
below. Unlike many people who are traumatised, they did not report
flashbacks. This may be a function of the distance in time between the
war and the memory.
Nightmares
I dream a lot Im shooting them, I tweak things off the bed table, I dream about it . . .
its like all silly dreams. Its like I say, Im shooting Germans but they dont go down
and they chase me and I cant get away from them. Im running and running but the
beggars are still behind me. I cant get away. Most peculiar, silly dreams.
Many veterans still regularly experienced war-related nightmares. One

still had them weekly, and has experienced them ever since the war. He
now experiences them with no greater or lesser frequency than at any
time since the war. Another has dreams about battle, and once (on an
anniversary) reported experiencing a physical response. On waking, his
wound scar was red and inflamed.
Dreams and nightmares are common among these veterans. Most
mentioned dreaming about the war; for some the dreams have occurred
ever since the war, for others they were more frequent in the early years,
for others they are more frequent now. There is no consistent pattern,
but such dreams play an important role in many veterans lives.
Guilt
Many veterans describe the experience of battle:
[driving in a tank, the driver said] Theres a wounded German officer, [and the
commander said] well I wont tell you what he said and we drove on. The only . . .
point about that was we werent squeamish I had a quick look, but of course the first
What kinds of memory are potentially traumatic? 147
thing in harbour at night was you had to clean your tank down. Fetching pieces of
German officer out of your tracks which wouldnt have been bad if hed been dead
but you realise you got him [speaking quietly] . . . That stuck in my mind, though it is
50 years ago next February when it happened.
This recollection has been through some cognitive processing, but
remains traumatic. The veteran was experiencing difficult emotions as
he was talking. It may be the guilt that is causing the problem that the
memory itself is manageable, but the guilt cannot be reconciled. This
demonstrates the complexity of the problems experienced by people
with these kinds of memories.
Others discussed the loss of friends, both at the time and seeing the
graves. Again there were feelings of guilt:
Why am I standing here looking at him [in the grave] and not the other way round?
Many traumatic recollections involve feelings of guilt, where the veteran

dwells on a particular action and goes over and over it in his mind. This
phenomenon has been studied by Kubany (1994) in relation to Vietnam
combat veterans, and by Davidson et al. (1990) in relation to the feelings
of guilt still experienced by WWII veterans. Going over the information in
the mind is not the same as processing. It is rumination, and is associated
more with depression than with PTSD. In constructive processing the
memory and the emotions are changed, yet with guilt they remain difficult
to reconcile. To have a feeling of guilt the veteran must have processed the
memory at one level, so why doesnt the feeling of guilt get processed?
Either the veteran did do something wrong for which he cannot atone
such as guilt at others dying or he is incapable of thinking at another level
and addressing the guilt. This is where the veteran may require assistance,
a means of providing a justification for his actions.
Atrocities
Other veterans describe atrocities that they witnessed:
I was with a sergeant one day and a German came out of a trench and this sergeant
killed him because he was crying because [his friend had been killed]. Of course he
was so upset and in fact he ran forward and killed two more Germans who were giving
themselves up.
Atrocities were undoubtedly committed on both sides, often in the heat
of battle, but most veterans were unwilling to discuss them. Atrocities
were either only committed by the enemy, or they had heard stories of
atrocities but had rarely witnessed or taken part or at least they rarely
admitted to witnessing or taking part.
Oh no, I never did that.

Although Ive a feeling it was done and Im not going to suggest it wasnt, because in
the heat of battle if you are disposed to violence in a group of six or seven people and you
have the opportunity of dealing with the men that did that what are you going to do?
These are the men that killed your friends . . . Well, we went a little berserk, thats the
only way to describe it because anything that moved, German or otherwise, they had no
opportunity ever. We never called on anyone to surrender . . . we just pushed and pushed
and pushed and that was the end of it, and eventually invariably they got killed.
It is difficult to put these kinds of memories emotions associated with
death, with being in battle into a coherent narrative, which is why these
kinds of memories continued to cause problems for traumatised individ-
uals. Again they may relate to guilt. The individual at the same time feels
angry the same emotions at present recall as when in battle and
guilty, knowing that such acts are criminal.
How do memories change over time?

I notice as you get older, memories get stronger and stronger for some reason. You do
think more now.
I can remember those things more easily than I can remember what happened a
fortnight ago. I suppose this goes with old age anyway. You tend to dwell on these things
because to you they were important then and theyre important now.
These quotations show the effects of age. People focus on what has been
important to them through their lives, and for many veterans this was the
war. It is important to distinguish between traumatic recollections and
the simple remembering of things past. Many of the war memories these
veterans focus on are not necessarily traumatic, but they are among the
most important events in their lives.
Coping with traumatic memories

They dont know they dont know they think its crazy 50 years, you should be all right
now . . . They ask you questions, they dont understand at all like what anybody thinks
or what theyve been through.
The psychological impact of wartime memories depended on the ways in
which older veterans coped with them (both during the war and since),
and on their general wellbeing, personality factors, social support, life
events and any age-related effects. Veterans present coping strategies are
partly the result of the strategies that they employed during and after the
war. This is particularly the case for avoidance, which was used when
veterans were in situations where they could not express emotion, and
soon after the war, when they were encouraged to forget about their
Coping during the war 149
experiences. Avoidance may be an effective coping strategy for many

years, when the veteran has a structured life, with work and family
commitments, but when this structure goes, it can lose its efficacy.
Coping during the war

The following are all strategies that veterans reported they adopted
during the war. Of course, there is no way of verifying these, and their
interpretations are likely to have changed over the years due to adapta-
tions and changes to the life story.
Avoidance
Avoidance was used as a coping strategy during the war, partly because of
training. Soldiers were trained to respond automatically to particular situ-
ations, to avoid thinking about the potential personal consequences of their
or the enemys actions. The individual who responds in such a way in
battle is more likely to perform effectively than the individual who becomes
distressed at the sudden death of comrades. Even after battle there was
usually little time or desire to think about, to grieve, these deaths. This use of
avoidant thinking may have led veterans to continue the use of the strategy
after the war via keeping busy with work and family commitments.
As we saw in Chapter 5, behaviour that is adaptive in a traumatic
situation, that helps someone survive, may be maladaptive outside of
that situation, but the person is conditioned to respond in a particular
way they have no choice in the matter.
Fatalism
Associated with the concept of avoidance is fatalism, where the individ-
ual accepts what is going to happen as inevitable, so there is little point in
worrying about it. There is a sense of acceptance with ones lot, that
there was no alternative to what would happen and what had happened.
This indicates a sense of helplessness with the situation, that the soldier
cannot have an effect on the situation. This is a passive coping strategy
that may have affected post-war coping responses, making it more diffi-
cult to actively process the traumatic information, leaving avoidance as
the best strategy available.
No choice
This is different from fatalism. Veterans felt there was no way of
escaping from battle. During the war people experienced many
different difficult situations that they were forced to either cope with or
die. POWs had to cope with particular difficulties. One ex-FEPOW
(Far East prisoner of war) kept himself together physically by eating the
rice polishings chewing slowly, then regurgitating at the point of
swallowing to chew again. This would both ensure maximum nutrition
and stave off the pangs of hunger. Others cut cigarettes in half to make
them last longer and to make them less hungry. For others the sense of
comradeship in the camps was important. Veterans also mentioned the
lack of choice when one is being shelled, that there is nothing one can
do about it.
Problems can arise when individuals do not have a means of actively
dealing with stressors. As Foa et al. (1989) showed, those who cannot
actively deal with stress often develop more psychological difficulties
than those who do actively deal with it. For instance, shooting at the
enemy is perceived to be less stressful than being shelled. In the former
situation the soldier is in control of the situation; in the latter he has no
control.
War as a justifiable cause

For many, the simplest form of coping was that the war was justifiable.
The idea of killing people was justified by claiming it was a job like any
other. It was sometimes linking it to the Nazi atrocities and propaganda
relating to what the Germans would do if they defeated Britain. Hitler
was seen as evil, and needed to be defeated.
Comradeship
As one of the most effective strategies for coping with the traumatic
events of war, comradeship is a sense of belonging to a group of people
who share similar experiences. Comradeship is difficult to define. Some
suggest it only existed between small groups of men fighting in the same
unit, others that the whole country was in comradeship. Comradeship is
not the same as friendship; it is deeper in the sense that comrades share
experiences and lifestyles friends normally wouldnt. Because it involves
sharing hardship and danger and that training prepares soldiers to
depend on one another for their lives, there is a very strong bond that
ties people together. On the other hand, comradeship is weaker than
friendship because of the nature of how the bond is created; one does not
choose ones comrades. It is not appropriate to consider comradeship as
weaker than friendship because of the ability to virtually ignore the death
of a comrade in battle.
Coping in the immediate post-war years 151
Something to live for

One FEPOW, held for 3 years by the Japanese in various camps,
described how he survived imprisonment using a picture. He was very
young when he was sent to India, and he took with him a picture of his
childhood sweetheart. In India he had it enlarged. He then went to
Malaya where he fought through the jungle, retreating to Singapore,
seeing some horrific sights along the way, where he was captured. He
had a typical FEPOW experience beatings, torture, tropical diseases,
overwork and not enough food. I asked him how he thought he had
survived. His main reason, he said, was that his girlfriend would be
waiting for him when he returned home. I asked him whether he ever
doubted that she would be waiting after all, it was a very long time, and
there was no indication of when it would all be over.
I was about 17 when I fell in love with my wife and then she was 1314 . . . Ive never
been with anyone else . . . I had her photograph with me all the time and I brought it
back, the same photograph that Ive had. It was a photograph Id had enlarged in
India, only an ordinary photograph, it was with me all the time . . . [Down in the] coal
mine, 12-hour shifts, but it was the thought that the wife would be here, knew that she
would be here when I came back . . .
NH: Did you ever doubt that she would wait?
No no.
NH: Never in the camps?
No.
NH: Even at your worst moments?
Never, never, never entered my mind that she wouldnt be here.
NH: Was she the main reason you survived?
Yes.
While I was interviewing him, she was cooking his dinner in the
kitchen.
Unfortunately, we do not have the stories of those who failed to
survive, and the reasons they lost their lives, and of course there are
many stories where girlfriends or wives did not wait.
Coping in the immediate post-war years

Veterans discussed the immediate post-war years in terms of the diffi-
culties they experienced with their memories and how they received little
psychological assistance to help them come to terms with their memor-
ies. After the war they were told that the memories would fade over time,
and their families were told not to discuss the war as this would create
problems. Both are now shown to be erroneous pieces of advice, for
which the long-term consequences are, for many, devastating.
There was no psychological support for most people. This itself may
have created or exacerbated many of the problems that came later.
Perhaps if they had been able to process the memories through counsel-
ling at the time, then there would have been fewer traumatic recollec-
tions now.
Just after the war I got blackouts you see, I had blackouts for a long time, I got dizzy . . .
They couldnt get me around . . . I had it very very bad . . . When I think of the daft
things, any noise of a car, something like that, Id be under the table, covering my eyes,
shivering with fright.
This lasted for 78 years. Fortunately, his wife helped him come to terms
with it. His wife helped him through years of psychological suffering. She
was his main source of support. Unfortunately, she died not long before
I interviewed him and this has led to a re-emergence of war-related
problems. If veterans have relied on their wives for many years as social
support, then the loss, whether through death or infirmity, may affect
their ability to cope at a time when they have fewer physical resources
themselves.
Coping in recent years

Many veterans have not learned to cope with their memories, or they are
experiencing problems for the first time in years, and there are situations
that arise where they have great difficulty. For one, the actual interview
was one of these situations:
[Just before you came I] nipped to the toilet and had a tranquilliser just to stabilise
myself, they would take about half an hour to work just to say to myself I could speak to
you, [otherwise] I would have probably been effing and butting and shouting.
Is processing an effective coping strategy?

As we have seen in Chapter 5, there is a debate regarding the nature of
cognitive processing. Research to date suggests that processing is an
adaptive coping strategy, but there is an argument for discriminating
between effective cognitive processing, which changes the nature of
the traumatic memory, and rumination, which is simple repetition of
the memory without inducing change. There is evidence for effective
processing.
One example is a veteran who explained how, whenever a difficult
memory came to mind, he would sit with a blank piece of paper and
write a poem. Afterwards, he reported, his memory would cease to be
problematic. Here are two examples:
Coping in recent years 153
The Camp
The Corps centre line ran alongside
Beech Wood. The leading division
Paused. Urgent calls crackled
Demanding medics, food, ambulances pronto.
Behind barbed wire skeletons with skins
Stared out from shaven skulls.
Around us neat piles of
Dead and dying, like logs
Layered criss-cross with dangling heads.
Bursts of fire from pale soldiers
Ended the slouching arrogance
Of guards who failed
To leap to instant orders
Officers turned a blind eye.
In this camp, poised on the tips

Of bayonets, hate and madness swayed.
Outraged love burst from the barrel of a gun.
There remained only tears
For the dying in Buchenwald.
After Falaise
His men, flung like discarded dolls,
Lay close around the young captain.
Old in war beyond his years he lay
Tranquil.
Ghouls, stealing through the bloated dead

Emptied wallet and holster and hacked away
His ring finger.
On his grey tunic, tight with corruption
Campaign medals and an Iron Cross flashed
Indifferent pride.
Around the corpse letters and snapshots
of a young woman and two fair children
Lay scattered.
Larger than death his sex had risen,

Still yearning for the new, young
Widow.
Another veteran provided further support for narrative development. He
was a Polish citizen caught up in the fighting in 1939. He was captured
and tortured by the Russians, before escaping to Hungary, where he was
sentenced to death by his compatriots because he refused to go back into

Poland. Saved from this by a passing relative, he was put on a ship for
Canada and Spitfire training. In the middle of the Atlantic his ship was
sunk, and he spent 17 days on a life raft. He reported that he managed to
survive because of two reasons: he had not said goodbye to his mother,
and he did not want to die a virgin. He made it to Canada, trained as a
pilot, and spent the rest of the war fighting the Germans. He did not
discuss this period, only the torture and the life raft they were his
traumatic times.
He still experiences some difficulty with his memories, as evidenced
by the emotions he displayed during the interview. On the one hand this
shows that processing does not eliminate traumatic recollections, just
makes them easier to deal with on a day-to-day basis, but on the other this
is a highly sensitive and emotional individual who is aware of what he calls
his emotional immaturity, his tendency to become emotional in many
situations. This shows that caution should be observed when drawing
conclusions if individual characteristics are not taken into consideration.
During the interview he explicitly stated that, when reporting events,
there was a change from the reliving of experiences to memory:
I can tell the story of it but [I am] not reliving [the] experience. It becomes memory,
in consciousness. Unless something triggered me it is just a story I remember.
Processing of the traumatic information has occurred here:
I think it is now more of a story and less of the actual experience.
This veteran is a sculptor and a poet (not the one who wrote the poems
above), a man of great imagination, a veteran of some horrific experi-
ences that caused him a lot of psychological distress, particularly in the
immediate post-war decade, including an over-dependence on his wife
that led to her temporarily leaving him, and to psychiatric treatment in a
hospital. In the first instance, traumatic recollections were experienced
as actual reliving of the event and, over time, the memories are translated
into a story. The story develops over time, with new elements of the
traumatic memory being recalled at different times, and then being
incorporated into the ever-changing narrative:
There are variants in what seems important at particular times.
Has avoidance become less effective in recent years?

Give sorrow words, the grief that does not speak
Knits up the oerwrought heart and bids it break
Macbeth
What role does social support play in veterans coping? 155
The first ten years after coming out of the army. I never told anybody, the wife and
daughter knew nothing about being a prisoner of war and all that.
This veteran never discussed his problems. When his memories emerge,
he still avoids them:
I try to do some little jobs you know like in the basement, I do a bit of joinery work and
things like that. When I get something Im interested in I can take me mind off that and
put it to that, thats how I cope and if in a morning Im having my breakfast about
what Ive been thinking in bed I go walking for two or three hours, thats how I cope . . .
people keep lending me military books like D-Day and all that. Id take it off them but
I never read it, Id say it were a good book but dont ask me what was insider I wont
read them now.
This policy of actively doing something different helps veterans to avoid

war-related thoughts. It is also something they may be less likely to be
able to do after retirement, or with increasing infirmity due to age. The
veterans interviewed in the present study all seem to suggest that avoid-
ance is an active strategy.
Avoidance stops a veteran from processing traumatic memories. Many
used avoidance as an effective coping strategy for many years, perhaps
the whole of their working life. It is only after retirement that for some
it ceased to be effective. It is a passive coping strategy with limited
effectiveness. It doesnt enable the veteran to live a symptom-free life.
War-related psychological difficulties may increase with age. The loss of
work structure associated with retirement means the individual has more
time to think, and if Butlers (1963) notion of a life review is accepted,
then individuals as they age will tend to dwell more on the past. The
problem is also in the changes that occur in ageing individuals cognitions.
Older individuals are less able to formulate newer memories, and so dwell
more on memories of the more distant past (e.g. Fromholt et al., 1995).
The avoidant coping strategy veterans have used for many years
becomes, after retirement, much less effective. As they do not have other
coping strategies to rely on, their traumatic recollections emerge and
create psychological difficulties. Avoidance has succeeded in keeping
traumatic recollections out of consciousness, but this has prevented the
individual from dealing with them unlike those who use processing
as a coping strategy.
What role does social support play in veterans coping?

Another common way of coping with the experience of war is to rely on
social support (Barrett and Mizes, 1988; Turner and Marino, 1994).
Social support is one of the most effective ways of dealing with stress
and trauma (e.g. Hassan, 1997). The Spanish Civil War provided evi-
dence that a situation of common danger reinforces morale (Hargreaves,
1939). Evidence for the use of social support here arises in three separate
examples: wives, comrades and veterans associations, with veterans using
such support in different ways according to whether they are with family
or other veterans.
Wives/family
The support received by veterans from wives has rarely been officially
acknowledged. Many took and take an important role in the care of
their husbands for many years, providing both practical assistance and
emotional support. The FEPOW described above, who took the photo
to India, says:
Shes been marvellous, marvellous like anything. I worship the ground she walks on.
Wives have not only provided the emotional support that veterans have
needed in the post-war years; many have had to provide their husbands
with practical help throughout marriage:
Shes more or less a nurse you know, I told the pension people she ought to get assistance.
If I had to go to hospital theyd pay for that but because shes here we dont get anything.
Millions of people in this country look after a mother or father for 50 years and get
nothing. Not fair really is it?
If the veteran loses his partner the person he has depended on then it
may be very difficult to cope if he has depended heavily on her over the
years. This is another reason why war memories may emerge. This
becomes more likely to happen as the veteran gets older. If he has
depended on his wife for emotional and/or practical support since the
war, then the joint effects of losing wife and losing support can be
extremely traumatic. This veteran got over his problems through the
support of his family, but not all veterans have such a family.
Comradeship
Comradeship helped veterans to cope with war, and it still exists for
some, often in the form of veterans associations. While comradeship
may be a source of social support, it may also function as a reminder of
traumatic recollections, which conflicts with its social support role.
Whatever function it provides, it is a bond that is difficult to break.
Comradeship is still important today for many veterans. While there
are differences in the ways that comradeship is perceived by different
Concluding remarks 157
individuals, it is generally seen as something that cannot be destroyed

by time. Comradeship was formed during the war years, initially in
training, and then in battle. It has continued to be important for many
veterans. Comradeship is seen as deeper than ordinary friendship, the
depth of the relationship arising because of the shared hardships, the
shared personal lives, and the sense of dependency for ones life on
others. Many veterans are still dependent on their comrades.
Veterans associations
For many veterans, these associations formed an important part of
their lives. They became more popular as time went by, coinciding
with veterans reaching retirement age. Veterans associations served
as a means of retaining or regaining comradeship, and providing
practical help.
Associations provided a means of remembering the war and the
comrades who were killed:
Next Sunday we go to Leicester for a commemorative service there. I suppose Ive got to
be honest we like to march and we love a good band to march to. A commemorative
service to try again to remember the pals youve lost, it doesnt do them any good, it
doesnt hurt you to remember them.
Meetings are generally regular, perhaps once a month, and veterans get
together to have a drink and a chat often about the war:
[We] get together and chat on wartime activities more than anything. We do go to
different places. Its a social evening really.
Veterans associations provide more than this; they have a supportive
role for veterans who are retired and in physical decline:
Its a question of welfare first of all.
Concluding remarks
Some veterans still experienced problems with their memories
many years after the war. There was evidence of both traumatic and
consummate memories, the former still causing emotional problems,
and the latter appearing to be resolved traumatic memories, or narratives.
Veterans have several ways of coping with these memories, via processing,
avoidance and social support. The results show the complexity of narra-
tives, the integration with social constructs common within society,
and how it is difficult to simply say that someone has resolved their
traumatic memories through the development of a narrative. It is more
complex than that. People may have developed their narratives, yet
still experience problems when they are faced with reminders. Others
perhaps most use avoidance as a strategy, and one that works in many
circumstances, though sometimes less so once the veteran retires.
The most frequently used coping strategy is avoidance. Many veterans
learned to use this strategy through their war experiences, where it was
an adaptive strategy, enabling the individual to carry on. After the war it
ceased to be adaptive, but veterans could, because they were very busy
working and building families, successfully avoid their traumatic recol-
lections. For many, this strategy has been successful almost to the
present day. It is retirement that has led to an increase in difficulties.
The veteran has more time to think, more time to dwell on his past life,
and if the war was the most important time of life, as many claim, then
they are more likely to dwell on that era. Perhaps it is retirement when
more people start to need narrative development, and when it is more
effective, than immediately after the event.
As shown in the previous chapter, social support is a complex
phenomenon. Wives and families provide both practical and emotional
support, but not as individuals with whom the war could be discussed.
On several occasions during the interviews, veterans would explain that
they were telling me things they had never told their wives. Why?
Perhaps wives are not appropriate audiences; they provide a safe and
protective environment, one which the veteran does not want to endan-
ger by discussing the emotional issues surrounding the war. Veterans
believed comrades understand their problems. Veterans who wished to
discuss the war find it easiest to discuss it with people who have had
similar experiences. This highlights the role of the researcher or clin-
ician. If the veteran is going to discuss his traumatic memories with
somone unknown, then it helps that he is not emotionally attached, as
the sharing of the memories does not endanger anyone, and it also helps
if the researcher or clinician has some understanding and awareness
of what the person has been through. Again, social support demonstrates
the important role of the audience in the expression of narratives.
A veteran has one narrative for his family, and another to share with
other people.
The permanent effects of war experience can be mitigated by appro-
priate coping strategies, but for many older veterans these strategies are
only partially effective. Wartime memories, even when processed into
narrative form, remain powerful, and can still generate intense emotions,
even after 50 years. Successful coping still means having to cope
throughout life. For many, this is becoming difficult due to the extra
problems created by ageing.
Concluding remarks 159
To best understand the interwoven processes of individual narrative

and social discourse, we should look at an ageing population, one in
which there have been many competing and contradictory social dis-
courses over time, and one in which individuals will have developed and
changed their narratives many times.
Baars (1997) argues that chronological time is overemphasised in
gerontological research. This is as true for veterans as for anyone else.
Veterans life stories often focus heavily on the war and the impact of the
war on their lives. According to Baars, we need to focus on comparative
concepts of time, which signify change but which also recognise the
importance of continuous identity. Changes are normally classified
according to peoples ages, but this is problematic as, in reality, an
individuals identity is a mixture of constancy and change, continuity
and discontinuity.
This demonstrates the usefulness of the narrative identity, which
focuses on the important events in a persons life. In order to understand
a life story, we can begin from a key event (for veterans, the war) and
build from that to understand the whole of life.
Currently, reminiscence theory tends to focus on the importance
of older people telling stories in order to keep themselves busy (e.g.
Coleman, 2005), but we should be using those stories in order to
improve our understanding about our culture, in order to remember
the past, and in order to have an impact on the world, for example
through educating younger generations. Narrative gerontology is a rela-
tively new field that explores this area from a narrative perspective
(Kenyon and Randall, 1999).
The importance of social discourses is important here. Second World
War veterans fought in an era where it was not generally acceptable to
break down, where the stiff upper lip remained fixed in British soldiers.
If you were upset by your experiences you did not show it; you did not
share your emotions with others. Many of the veterans recognised this
problem, and drew a distinction between the way they see the world and
the way younger people see the world. Problems can arise as these men
age. Veterans views often remain the same, but society changes around
them. As society starts to believe that people should express their emo-
tions, veterans should discuss their problems. But the veterans may find
it difficult or impossible to change. Their upbringing was that of the stiff
upper lip. Hence we have a disparity between the memories of the
individual and current societal discourse.
Studying older people and their war experiences shows that memory is
useless without meaning, without the social context. This has been
understood at least since the time of the Ancient Greeks. It is only
recently that psychologists have begun to acknowledge the importance of

meaning in memory (Hunt and McHale, 2008). Memories are
developed and changed through the use of individual narratives (this is
a normal human process) and an integration of these narratives with
social discourses. If we wish to understand memory we must understand
the social context in which people live and have lived. In order to do this
psychologists should consult with historians, sociologists and others to
build the social world through which people have lived, in an attempt to
integrate personal memories and the social world. Individual memories
form key components of individual narratives; whether and how these
memories are recalled ultimately depend on these narratives. Without
the narrative there is no memory. Clinical psychologists and other ther-
apists must move away from only trying to understand individual trau-
matic memories and incorporate the use of narrative approaches when
they are considering the impact of traumatic memories on their clients.
11 Literature and trauma
The use of literature (novels, poetry) can both support the psychological
evidence we obtain regarding the impact of war, and, in some circum-
stances, help to develop our understanding. A common way for many
people to deal with their traumatic memories is to write them down as a
story; this, for some, is an effective way of dealing with memories. It is
not just literature, but also films and plays. Perhaps the best-known
example of a film director dealing with his own nightmares is Oliver
Stone, with his series on the Vietnam War, in which he fought. Several
books could be written about the different ways in which traumatised
people have dealt with their traumatic experiences by getting their work
published. Many other books could explore all the manuscripts that have
not been published.
Psychologists have traditionally ignored literature as a potential source
of data. Analysis of literary sources can potentially provide psychologists
with rich data from which to develop and test psychological theories.
The traditional scientific approach of psychology has occasionally been
unscientific in focusing too much on methods and too little on examining
the theories they are interested in testing. After all, the nature of psycho-
logical data can include all behaviours of people, including writing.
Our understanding of the psychological effects of war benefits by a
detailed consideration of literature published in the area. Apart from
a means of validating theory, it provides an opportunity to explore
responses to war trauma in other times and cultures. For instance,
Hanley (1991) reviewed the literature regarding women and war, inter-
spersing this with her own short stories fictionalising accounts of real
experiences (see Cobley, 1994) and provided the reader with an
understanding of the trauma of war from a womans perspective.
Literature has provided countless examples of how soldiers cope with
war experience. Wilfred Owen was shellshocked during World War One
and was sent to Craiglockhart hospital outside Edinburgh for treatment.
Through his work he describes instances of many concepts current
to psychotraumatological theory. Re-experiencing, a key component of
161
PTSD (American Psychiatric Association, 1994), is described in Owens

poem Strange Meeting, where he describes in detail a soldiers nightmare.
Another key symptom of PTSD avoidance is described:
Why speak not they of comrades that went under?
Elsewhere he describes the battle that won him the Military Cross:
I can find no word to qualify my experiences except the word SHEER . . . it passed the
limits of my abhorrence. I lost all my earthly faculties, and fought like an angel.
(Hibberd, 1992)
Losing all his earthly faculties shows how in battle soldiers can fight
automatically, as highly trained warriors without conscious thought.
We know that trauma research has demonstrated the importance of
developing a narrative or story about the traumatic event (e.g. van der
Kolk and Fisler, 1995; Hunt and Robbins, 1998). Shay (1994) provides
a poetic example of the importance of these narratives for veterans. It is
a means by which they stay sane:
I will tell you something about stories . . .
They arent just entertainment.
Dont be fooled,
They are all we have, you see,
all we have to fight off
illness and death. LM Silko, Ceremony (in Shay, 1994, p. 183)
This encapsulates the role of writing in dealing with traumatic memories
at least for those who write.
Jonathan Shay (1991, 1994) produced an excellent contribution to
our understanding of the importance literature can play in helping
psychologists to understand more about war trauma. Shay is a psych-
iatrist who had been heavily involved in the treatment of US Vietnam
War veterans. He found that the veterans were experiencing problems
that were beyond the scope of PTSD, that they were describing things
that had happened to them in war, and symptoms they experienced, that
were just not in the clinical textbook. Shay made a comparison between
the experiences of these veterans and the experiences of Achilles in the
Iliad, and showed that a reading of Homer would educate the therapist
about what to expect from war veterans. Shay argued that Homer,
through the experiences of Achilles, managed to convey the complexity
of the response to war trauma that it is not just about symptoms of
PTSD, but also about comradeship, guilt, anger, antipathy to leaders
who make poor decisions, and the madness (berserk) that happens to
men on the battlefield. Any clinician wishing to understand war trauma
should read both the Iliad and Shays interpretations.
All Quiet on the Western Front (Im Westen nichts Neues) 163
Tragedy
The concept of the tragedy has been used in drama throughout history.
Drama is often about traumatic events and the ways in which people deal
with them. Krook (1969) looked at tragedy in literature and identified
four stages: (1) Precipitant: the act of shame or horror tragic circum-
stances always arise from the fundamental nature of humans;
(2) suffering: this is only tragic if it generates knowledge or insight or
understanding of the fundamental nature of humans; (3) Knowledge;
and (4) affirmation; of the worthwhile nature of human life and the
dignity of the human spirit. Tedeschi et al. (1995) used this to consider
how traumatised individuals can benefit from the insights gained after a
traumatic event. War trauma can be considered in the light of these
stages. Effective processing of emotional traumatic memories is directly
analogous to the model of tragedy. There is a traumatic event which
involves suffering, and the individual who successfully processes the
information gains knowledge and understanding of themself and also
of the true nature of what it is to be human.
The construct of post-traumatic growth was discussed in Chapter 6.
Tragedy provides good examples demonstrated through tragic litera-
ture of how people, after a traumatic event, learn from the event in
terms of increasing wisdom (processing and growth).
If trauma victims believe that their suffering has no meaning, if it
cannot be interpreted in terms of saving civilisation or doing a worth-
while job of work, then it becomes despair (Frankl, 1963/1984). In order
to successfully process the traumatic recollections, trauma victims must
recognise the meaning of their suffering. This is not a matter of reverting
to a former state, but an acceptance that things are permanently
changed, and thus a learning experience. Many veterans acknowledge
the beauty of the simplicity of life, the value of others and of relation-
ships, in a way that they did not prior to combat experience. It could be
argued that they would have learned this anyway with increasing age and
wisdom, but it is very likely that their experiences enabled them to alter
the ways in which they look at the world.
All Quiet on the Western Front

(Im Westen nichts Neues)
A generation of men who, even though they may have escaped its shells, were destroyed
by war. Erich Maria Remarque
All Quiet on the Western Front (AQOTWF) was written by Erich Maria
Remarque and published in 1929. It was written in 6 weeks, became an
instant success, and was translated into English by A. W. Wheen (Barker

and Last, 1979). For many people it is the best work of fiction ever
written about war. Remarque served on the Western Front in 1917, and
it is commonly accepted that AQOTWF (along with its sequel, The Road
Back) was written as a semi-autobiographical account of Remarques
experiences.
We can examine AQOTWF in terms of the experiences of the main
character, Paul Baumer, and his comrades, to show how greater psycho-
logical understanding can be obtained by using works of fiction as
psychological data.
Method
The data source is AQOTWF, the Wheen translation (Remarque,
1929). The book was analysed using a grounded approach (Strauss
and Corbin, 1998). Appropriate quotations were coded, typed into
Word and coded. Concepts arose out of the initial coding. These codes
were then grouped under conceptual headings which could then form
the basis for developing a theoretical model. This type of model is not
developed here but it is used simply to illustrate the use of literature.
The resultant conceptual structure is presented in the Results section
below, with the main category headings presented as subheadings. For
a more detailed explanation of this method, see Hunt (1999).
Results
The following is not a comprehensive analysis of AQOTWF, but focuses
on a restricted number of themes: battle experience and understanding,
memory, the past and the future, and coping.
Battle experience and understanding

Remarque tries to provide the reader with an understanding of what
soldiers experienced. This is difficult because, as he indicates, it is not
possible to put into words the experiences that the soldiers had:
Attack, counterattack, charge, repulse these are words, but what things they signify.
(p. 88)
This demonstrates the difficulty with understanding verbal accounts
(of any kind). The words used may not fully describe the meaning the
writer wishes to portray.
Memory 165
The lack of understanding in non-combatants, i.e. civilians, is best

illustrated when Paul is at home on leave:
Suddenly my Mother seizes hold of my hand and asks falteringly: Was it very bad out
there Paul?
Mother, what should I answer to that! You would not understand, you could never
realise it. And you never shall realise it. (pp. 1078)
He recognises that others are willing to try and understand, but they
cannot do so:
They understand of course, they agree, they may even feel it so too, but only with words,
only with words, yes, that is it, they feel it, but always with only half of themselves, the
rest of their being is taken up with other things, they are so divided in themselves that
none feels it with his whole essence. (p. 113)
While Remarque recognises the divide between those who have and
those who have not experienced the traumatic event, he does attempt
to show what battle was like. For instance, the bombardments they
regularly endured:
The shelling is stronger than everything. It wipes out the sensibilities. (p. 49)
Each man lays hold of his things and looks again every minute to reassure himself that
they are still there. The dugout heaves, the night roars and flashes. We look at each other in
the momentary flashes of light, and with pale faces and pressed lips shake our heads. (p. 73)
The wounds on the battlefield:

We see men living with their skulls blown open; we see soldiers run with their two feet cut
off, they stagger on their splintered stumps into the next shell hole; a lance-corporal
crawls a mile and a half on his hands dragging his smashed knee behind him; another
goes to the dressing station and over his clasped hands bulge his intestines; we see men
without mouths, without jaws, without faces; we find one man who has held the artery
of his arm in his teeth for two hours in order not to bleed to death. (p. 91)
Memory
In order to understand psychological trauma we have to understand
traumatic memory, though relatively little of the novel is concerned with
memories. AQOTWF is set during the war. Paul and the others are not
looking back, they are living through the traumatic experience of war.
Remarque demonstrates that the soldiers avoided thoughts of the past,
of civilian life, because this led to problems. In extreme cases this could
lead to desertion, such as in the case of Detering, who was finally broken
by the sight of blossom on a tree that reminded him of his home on the
farm. He disappeared and was not heard of again, with the implication
that the military police had caught and shot him.
Traumatic events do lead Paul to think about the past. An example

is when his school-friend Kemmerich has died:
Thoughts of girls, of flowery meadows, of white clouds suddenly come into my head . . .
I feel my joints strong, I breathe the air deeply. The night lives, I live. I feel a hunger,
greater than comes from the belly alone. (p. 27)
The suddenness of his friends death makes life suddenly become more
important again. Most of the time Paul accepts the reality of the battle-
field, but this death acts as a reminder that in civilian life things are
peaceful and life is secure. When soldiers are reminded of these times it
creates difficulties, because the memories will not go away easily, as
when Albert asks Haie about what he will do when there is peace:
Haie looks at him sadly and is silent. His thoughts linger over the clear evenings in autumn,
the Sundays in the heather, the village bells, the afternoons and evenings with the servant
girls, the fired bacon and barley, the carefree hours in the ale house He cant part with
all these dreams so abruptly; he merely growls: What silly questions you do ask. (p. 57)
The soldiers know the danger of allowing themselves to be taken over
by their memories:
[Memories] are always completely calm . . . It is the alarm of their silence that forces me
to lay hold of my sleeve and my rifle lest I should abandon myself to the liberation and
allurement in which my body would dilate and gently pass away into the still forces that
lie behind these things. They are quiet in this way, because quietness is so unattainable
for us now. (p. 82)
These memories create difficulties for Paul. Perhaps the worst occasion
is after coming back from leave, when he finds it difficult to come to
terms with being in the front line again:
What is leave? a pause that only makes everything after it so much worse. (p. 119)
These examples illustrate how the soldiers have problems with memor-
ies, that memories of other times can intrude and make life difficult or
impossible to bear. In order to succeed at the front the soldiers have to
relinquish much of what makes them human, the ability to look into the
past and the ability, as we shall see, to explore the future. They have to
live for the present, because when they realise that the past and the
future exist, they may break down.
The past and the future

Remarque pessimistically suggests that the future is lost to this genera-
tion. He believes that the older soldiers will survive psychologically
because they have homes to return to, lives already established, but the
The past and the future 167
younger ones, those who were adolescents when they joined the Army,
had laid down few roots and so there is nothing for them:
They have a background which is so strong that the war cannot obliterate it. We young
men of twenty however have only our parents, and some, perhaps, a girl that is not
much, for at our age the influence of parents is at its weakest and girls have not yet got a
hold over us. (p. 19)
Memories of the past give an indication of how the future might be if
only one could survive the war. But once one begins thinking in this way
then one cannot perform effectively as a soldier, for instance becoming
unwilling to go over the top because of the fear of death becoming
predominant.
This way lies the abyss. It is not now the time but I will not lose these thoughts, I will
keep them, shut them away until the war is ended. My heart beats fast: this is the aim,
the great, the sole aim, that I have thought of in the trenches; that I have looked for as
the only possibility of existence after this annihilation of all human feeling; this is a task
that will make life afterward worthy of these hideous years. (p. 128)
The war has fully taken over for the young men there is no future other
than the war because there are no memories of adulthood from before
the war:
He is right. We are not youth any longer. We dont want to take the world by storm. We
are fleeing. We fly from ourselves. From our life. We were 18 and had begun to love life
and the world; and we had to shoot it to pieces. The first bomb, the first explosion, burst
in our hearts. We are cut off from activity, from striving, from progress. We believe in
such things no longer, we believe in the war. (p. 61)
The loss of purpose appears to be known to Paul and the others while
they are still in the trenches. It is confusing; on the one hand we are led
to believe that the soldiers do not think about the past or the future, on
the other that they do and have done in great detail, thinking through
the consequences of the war years. Do we have here an example of
dissociation?
Remarque is concerned with how the men will be unable to do
anything in the future because:
Through the years our business has been killing - it was our first calling in life. Our
knowledge of life is limited to death. What will happen afterwards? And what shall come
out of us? (p. 173)
This destruction of a generation is a very important theme throughout
the book. Erikson (1982) proposed that there are seven stages of life,
and that the transition from adolescent to adulthood is critical. This is
when we develop our identities independent of parents. Remarques
argument is that this stage transition was shattered, and that as Erikson
proposed this will have profound effects on the abilities of the soldiers
to adapt to post-war life.
Had we returned home in 1916, out of the suffering and the strength of our experiences
we might have unleashed a storm. Now if we go back we will be weary, broken, burnt
out, rootless, and without hope. We will not be able to find our way any more.
And men will not understand us for the generation that grew up before us, though it
has passed these years with us already had a home and a calling; now it will return to its
old occupations, and the war will be forgotten and the generation that has grown up
after us will be strange to us and push us aside. We will be superfluous even to ourselves,
we will grow older, a few will adapt themselves, some others will merely submit, and most
will be bewildered;- the years will pass by and in the end we shall fall into ruin. (p. 190)
This has implications for recent work on long-term effects of trauma
(Hunt, 1997). Remarque is showing that this shattering of lives shall be
permanent for many of the soldiers, that what is being destroyed on the
battlefield shall never be rebuilt.
Coping
Through much of the book Remarque shows how Paul and his comrades
use various coping strategies, including avoidance, comradeship and
dehumanisation. These strategies concur with psychological research
(e.g. Elder and Clipp, 1989; Hunt and Robbins, 1998).
Avoidance is perhaps the most important means of coping used by the
soldiers on the battlefield. Soldiers are trained to fight battles. Through
training, they are prepared for their traumatic experiences. Training
develops both unit cohesiveness and the ability to respond automatically
in given situations (Watson, 1978). During wartime these skills are
adaptive. The individual who is part of a unit where he can trust his
comrades and who responds automatically to life-threatening situations
is more likely to come out of battle alive than the one who does not have
these advantages. Avoidance also stops men from thinking too much.
There are many examples of avoidance in AQOTWF, relating specif-
ically to avoiding particular subjects such as thinking about a recent
battle:
Often we lay aside the cards and look about us. One of us will say; Well boys . . . Or It
was a near thing that time . . . And for a moment we fall silent. There is in each of us a
feeling of constraint. We are all sensible of it; it needs no words to communicate it. (p. 12)
It can occur during the battle itself. In a bombardment the soldiers are
close to breaking down because there is nothing to do except wait to see
if a shell falls on them. Having an active task enables the soldiers to avoid
thinking about the danger to their lives. At one point:
Coping 169
We are buried and must dig ourselves out. After an hour the entrance is clear again, and
we are calmer because we have had something to do. (p. 74)
Avoidance has to be employed:
Habit is the explanation of why we seem to forget things so quickly . . . They are too
grievous for us to be able to reflect on them at once. If we did that, we should have been
destroyed long ago. I soon found out this much:- terror can be endured so long as a man
simply ducks;- but it kills if a man thinks about it. (p. 93)
The same attitude is used in regard to friends and comrades who have
been killed. The soldier is not allowed to grieve, and uses active strat-
egies to avoid thinking too much about such people:
The terror of the front sinks deep down when we turn our backs upon it; we make grim,
coarse jests about it, when a man dies, then we say he has nipped off his turd, and so we
speak of everything; that keeps us from going mad; as long as we take it that way we
maintain our own resistance. (p. 94)
Avoidance is not about forgetting, and it can only be an effective strategy
for a limited length of time:
But we do not forget. Its all rot that they put in the war-news about the good humour of the
troops . . . We are in a good humour because otherwise we should go to pieces. Even so we
cannot hold out much longer; our humour becomes more bitter every month. (pp. 945)
Avoidance is not always effective:

rarely does an incident strike out a spark. But then unexpectedly a flame of grievous and
terrible yearning flares up. Those are dangerous moments. They show us that the
adjustment is only artificial. (pp. 1789)
Dehumanising the enemy is essential to ensure that the soldier can
perform effectively. If Paul treated the enemy as fellow human beings,
they would not be effective soldiers, and they would be unable to go out
and kill the enemy if they, for one moment, perceived they were human.
But this can happen:
Under one of the helmets a dark pointed beard and two eyes that are fastened on me.
I raise my hand, but I cannot throw into those strange eyes. (p. 78)
The breakdown of dehumanisation is best illustrated in the scene where
Paul is trapped in a shell hole in no mans land with a French soldier he
has wounded:
You were only an idea to me before, an abstraction that lived in my mind and called
forth its appropriate response. It was an abstraction I stabbed. But not, for the first time,
I see you are a man like me. (p. 147)
Paul feels guilt for having killed the man:

His name, it is a nail that will be hammered into me and never come out again. (p. 147)
This man is bound up with my life, therefore I must do everything, promise
everything in order to save myself; I swear blindly that I mean to live only for his
sake and his family. (p. 148)
But this feeling does not last. Paul, in order to survive, must again
become an unthinking soldier:
I think no more of the dead man, he is of no consequence to me now. With one bound the
lust to live flares up again and everything that has filled my thoughts goes down before
it. (p. 149)
The idea of dehumanisation extends also to ones dead comrades. Paul

describes visiting the mother of his dead friend:
Why doesnt she stop worrying [about how Kemmerich died]. Kemmerich will
stay dead whether she knows about it or not. When a man has seen so many dead he
cannot understand any longer why there should be so much anguish over a single
individual. (p. 46)
Conclusion
This analysis illustrates how literature can be used as data to enhance
our understanding of the response to war trauma. As Shay used the Iliad,
we can use AQOTWF. Remarque (1929) demonstrates a depth of
understanding about the consequences of battle experience, the memor-
ies, the problems associated with the family, or of coping through avoid-
ance. Two areas that are not dealt with well in the psychological
literature are: (a) dealing with war through dehumanisation, and
(b) descriptions of battle experience and the immediate impact on
participants. AQOTWF is an eloquent expression of the use of narrative
in coping with memories. It deals with notions of past and future, and
the ways in which men experienced dissociation with regard to these
concepts, at the same time rejecting both and yearning for both.
AQOTWF describes in great detail the ways in which men dealt with
the suffering on the Western Front.
The concepts of processing (narrative development) and avoidance
are well described in the literature (Creamer et al., 1992; van der
Kolk and Fisler, 1995), but descriptions of the experience of battle
and dehumanising the enemy are rarely discussed. Neither is there a
clear understanding of how and why verbal descriptions are inadequate
to describe traumatic experiences, though this has implications for all
psychological work involving linguistic data.
Remarques personal experiences can be interpreted using Krooks
(1969) four stages of tragedy. For Remarque the precipitant was the
Conclusion 171
war and the suffering the trenches. Through this came knowledge
about the nature of people and how they deal with difficult situations.
Affirmation is concerned with Remarques post-war life, how his books,
including AQOTWF, illuminated facets of peoples lives, far beyond
simple notions of trauma. Could Remarque have been a novelist had
he not experienced the trenches of the First World War?
While literature should not be considered as a substitute for the
scientific analysis of the consequences of trauma, it is useful to use
such writings to triangulate with our psychological theories. A note of
caution, though: novels are not designed to be data they are stories
about aspects of the world from the perspective of the writer. In the case
of writers with battle experience, they may tell us something about what
it is to be traumatised, but there are dangers of over-interpretation.
Literary theory is full of interpretations of what writers are trying to
say, but as Umberto Eco points out, there are limits to what we can make
a text mean (Eco, 1992). There is the danger that we may be claiming
more from a novel than the author actually intended. Nevertheless, our
understanding of war trauma can be enriched by the study of works of
literature, novels and poems written by war veterans and others.
12 Memorialisation and commemoration
The purpose of this chapter is to show how memory, narratives, social

discourse and history are interlinked via the remembrance of war, and
how people have a psychological need and a social duty to remember
those who died in past wars.
Societies have always used memorials to help them to remember past
events or people. Commemoration is probably the most heavily traf-
ficked point of intersection between history, sociology and political
science (Wilson, 2005) and the place of commemoration in the con-
struction of group, particularly national identities. Psychology also has
an important role to play here, as it is concerned with the role of
individual memory and how the individual fits within the social context
of such events. Memorials can be instituted by the state or by private
individuals; they can be public or private (e.g. Quinlan, 2005b). British
war graves, instituted in their present form after the First World War,
are uniform except for the message at the base, where families are
permitted to add a short message (even these employ a common social
discourse, with the same phrases occurring repeatedly). The graves are
institutional and public. In old battlefields such as the Somme, new
memorials, privately funded but in public positions, are still being
erected, long after the participants in the event are dead. These are
attempts to ensure that the memories of particular individuals or
groups are remembered by later generations, perhaps with the fear that
they are being forgotten? The other main type of public memorial in
Britain is the village or town war memorial, individually designed and
erected shortly after the First World War, usually paid for by local
subscription. There are very few villages in Britain that do not have
such a memorial. (These are the so-called thankful villages, which did
not experience any deaths; there are estimated to be fewer than thirty
such villages.) War memories are kept alive through the Remembrance
Day events held throughout the country in November each year.
What we do not know is how these memories of war are held by the
generations that come after the war is over.
172
Ritualisation and commemoration 173
Memorials help us to remember the wars and the people they

commemorate. They are societys way of reminding us of war. According
to Nora (1989), who was discussed in Chapter 7, memorials are
examples of lieux de memoire, meaningful entities of a real or imagined
kind, which have become the symbolic elements of a given community as
a result of human will or the effect of time (p. 7). Such lieux de memoire
are ultimate embodiments of a memorial consciousness that has barely
survived in a historical age that calls out for memory because it has
abandoned it. We have commemoration because it is the nostalgic
dimension of these devotional institutions that makes them seem belea-
guered and cold they mark the rituals of a society without rituals
(p. 12). This is a rather harsh assessment of the role of memorials and
commemoration in society, but Nora has a valid point. His position is
that, as we now have no spontaneous memory, we must deliberately
create archives, maintain anniversaries and organise commemorative
events because these things no longer occur naturally. As Nora states,
without commemorative vigilance, history would soon sweep them
away (p. 12). As discussed in Chapter 7, we have lost our sense of
memory, replacing it with history and, because of our psychological
need to remember, we create specific perhaps artificial memorials
to use for commemoration.
As Thelen (1990) argues, memory exists along a continuum of experi-
ence, with one end being the individual and private memories, kept alive
in part by the development of individual narratives, and the other end
being the collective cultural and public memories, which are kept alive
at least in part through memorialisation.
Ritualisation and commemoration

Durkheim (1947) developed his theory of ritual and collective represen-
tations through an analysis of commemoration. There is a strong need
within people to have ritual, a series of fixed behaviours that are agreed
by people in society and that represent, in terms of commemoration, a
formal way in which we remember something of the past. Perhaps the
best example in the UK is the two-minute silence, which was introduced
shortly after the First World War and quickly ritualised into society, so
that, at 11 a.m. on 11 November every year, everything would stop.
People would stand with heads bowed, vehicles would stop, work would
cease, while everyone remembered the dead of the war. The ritual of the
silence means that there is a shared memory, a social discourse that
ensures society will not forget the dead.
Heritage and commemoration

Heritage was discussed in Chapter 7, where it was considered, rather
negatively, as being a means of preserving a fixed idea of the past, rather
than enabling and allowing reinterpretation. Here we can look at
heritage in a little more detail. Knox (2006) argues that the relationship
between tourism and war has received little attention. While this is
probably true regarding tourism academics, Lennon and Foley (2000)
discussed the importance and interest of so-called dark tourism, the
attraction of sites of battle and sites of death, particularly in relation to
the recent history of war. This is an example of how there is a develop-
ment from memory (personal and collective) to history (impersonal and
argued) to heritage, which is where events in the relatively distant past
become fixed and unchangeable according to the ideas of the present.
The heritage industry is massive, with a large proportion of heritage sites
being related to battles (e.g. Bosworth, Hastings) or to war-related
structures such as castles, particularly those ruined by distant wars.
More recent battles, such as Normandy and the Somme, are not yet
heritage sites. They are still picked over by the people who fought there,
and their immediate descendants. They are argued over by academic
and amateur historians, and they have not yet attained the status of
heritage site. That is, they are not yet sites dead to memory; they are
not heritage sites. This is because they are still remembered, there are
still survivors, and there are still people whose fathers and grandfathers
fought at these sites.
Knox (2006) discusses the memories of the massacre at Glencoe, and
how these memories dominate the heritage visions and interpretations of
the valley. Performative acts and utterances make and remake the
sacralised landscape (p. 185). These events become concrete as they
become heritage tourism. Knox is intrigued by how events that appear to
have little connection to modern life continue to have a resonance
beyond what we might expect. I have already discussed this in relation
to the English Civil Wars of the 1640s. Knox provides the example of
Glencoe, which has lost much of its emotive and terrorising power of a
site of remembrance but which still retains a force among some groups.
Glencoe is important to Scots as it helps to differentiate Scottish from
English culture, which is important for those Scots who wish to obtain
independence. More interestingly, on 13 February each year, there is a
gathering at the MacDonald Monument to commemorate the 1692
massacre. Interestingly, the locals have little interest; most of the attend-
ees come from the USA is this demonstrating the need for heritage,
for a past, by people from a heritage-free nation?
The Commonwealth War Graves Commission 175
Heritage involves manipulations and untruths for the benefit of a good

story. Mythology is often about telling deliberate lies or half-truths. On
other occasions we construct the story because we do not know what
really happened. When we get to the stage of heritage, it can be argued
that we do not commemorate in the same way as we commemorate
events in living memory. When we remember the Civil War, we do not
think of particular individuals in the same way as when we remember the
dead of the World Wars. But the question is not if, but when, will the
latter events slip into heritage?
The WWI example is probably the largest scale memorialisation and
commemoration in the world. It was the start of how we commemorate
and has continued to the present day. While remembering wars and
battles has occurred throughout history, most of the memorials we see,
at least in Europe, date from the First World War or later. There are
memorials to other wars and battles, such as at Waterloo, or to some of
the sites of the English Civil War, and there are memorials to the
Crimean War and to the Boer War, but these are relatively rare. There
are probably two major reasons why memorialisation and commemora-
tion did not occur on a very large scale before the First World War: first,
that most wars involved relatively few people, so there was no national
need for a national memorial, and second, that up to the First World War
there was little regard for the ordinary person, so if several hundred or
several thousand men die, then it is of little concern for the ruling classes
or those who could afford memorials. Pre-WWI memorialisation with
notable exceptions is more often about a single officer from a rich
family than a memorial to all the dead. Memorials representing the men
were often erected many years afterwards.
The Commonwealth War Graves Commission

The Commonwealth War Graves Commission (CWGC) was set up by
Royal Charter in 1917, during the First World War. As stated on its
website (www.cwgc.org) it was established to commemorate the
1,700,000 people of the Commonwealth forces who died in the two World
Wars. It has around 1,500 cemeteries in 150 countries in the world. The
largest cemetery, Tyne Cot in Belgium at the site of the battle of
Passchendaele in 1917 (where one of my own relatives died on the first
day; see Chapter 13) has about 11,000 graves; the smallest, on the Isle of
Skyros, has just a single grave. There are also memorials commemorating
the three-quarters of a million who have no known grave, the two most
memorable being the Menin Gate at Ypres, and the Lutyens-designed
monument at Thiepval on the Somme (see Stamp, 2006).
The CWGC keeps records of all the dead, and there is a searchable
database where relatives of those who have died, and anyone else with an
interest, can find details, including place of burial (if any).
The Cenotaph
Much of this and the following section is based on the book Remembrance
by Mark Quinlan (2005a), which provides a detailed account of many of
the key memorials for the CWGC, along with some fascinating back-
ground about how they came to be erected. There is also a series of short
biographies of some of the key figures who worked on the memorials.
He has also written another volume, British War Memorials, focusing on
the British memorials. Remembrance relating to the First World War is a
fascinating case of bringing together the need to remember the dead
through memory and commemoration. At the end of the war the British
Government wanted a day of celebration to mark the signing of the
Treaty of Versailles in June 1919. At this point, there was some nervous-
ness about the attitudes of serving and demobilised soldiers, and also
unrest within the labour force. As so often after a war, there were many
discontented and often unemployed men. The Victory Parade was, in
part, an attempt to draw the nation together to both celebrate the
successful (or so it was thought) end of the war, and to commemorate
the dead. The French were arranging to have a march past the Arc de
Triomphe, where a temporary catafalque was to be erected and
which the soldiers would salute. The British Government thought this
was a good idea and commissioned Sir Edwin Lutyens to design the
Cenotaph. This was to be non-denominational, and he had two weeks to
design it and get it built. Lutyens met with the Principal Architect of
Works, Sir Frank Baines, and sketched out his design. Lutyens gave it
the name Cenotaph, which was simply an empty tomb on a high
pedestal. The word derives from the Greek words kenos (empty) and
taphos (tomb). The origin is from the importance the Greeks attached
to burying their dead, even if there was no body. This links neatly with
the memorials to the dead who have no known grave at Thiepval on the
Somme, and the Menin Gate and the remembrance wall at Tyne Cot
Cemetery.
The Cenotaph was built and used for the victory celebrations, and it
caught the publics imagination. It was temporary, and meant to be
removed after the parades, but the public wanted a permanent memor-
ial. After discussion in Parliament, it was agreed. Westminster Council
initially objected to its site, but there was public acclaim for it to be
on the site in Whitehall that was occupied by the temporary structure.
The Unknown Warrior 177
After some debate, Lutyens was commissioned to design the permanent

stone structure that still stands. The structure cost 10,000 to make. It
was this expensive because of the subtleties of design. Apart from its
simplicity and lack of decoration, the stones have the smallest joints seen
since the Parthenon was built. Neither does it have a single vertical or
horizontal line. Lutyens drew on the Greek principle of entasis, where
curved surfaces give the impression of being straight. All of the surfaces
are spherical. The verticals would converge at a point over 1000 feet
from the ground; the horizontals are part of a circle that has a centre
900 feet below ground. The height of the Cenotaph is 35 feet, and it is
constructed from 120 tons of Portland Stone. Initially, the only writing
on the Cenotaph was: The Glorious Dead and the dates of the war,
MCMXIV to MCMXIX. After the Second World War, the dates
MCMXXXIX and MCMXLV were added. The Cenotaph deliberately
avoided any religious symbol, because it was intended to commemorate
all creeds and none.
The Cenotaph was unveiled on 11 November 1920, taking place on
the same day as the funeral of the Unknown Warrior in Westminster
Abbey. Since then, it has formed the national focus for the UKs remem-
brance services. It led to many copies being placed around the country.
The Unknown Warrior

One of the biggest difficulties for people who have suffered the loss of a
loved one, whether in war or in other events, is when there is no body to
grieve over. This happened a lot in the First World War. There were
several solutions to this. The biggest were the memorials at Thiepval
(over 72,000 names) on the Somme, and those at the Menin Gate
(nearly 55,000) and the Tyne Cot wall (nearly 35,000) in Belgium.
These monuments contain the names of all those killed with no known
body across the two battlefields. An alternative, and perhaps more
personal, idea derived from a British Army chaplain, David Railton
MC, who noticed a grave near Armentie`res in France, with the words,
An unknown soldier of the Black Watch written on the cross. After the
war he raised the issue of a grave for the Unknown Warrior, where a
body would be chosen to represent all those who had died and which
would be a memorial for all the grieving relatives, as no-one would know
whose son was buried in the grave. After some debate, the idea was
accepted.
The body was to be chosen from one of four unknown British service-
men who were exhumed from the battlefields of the Aisne, the Somme,
Arras and Ypres. Each was taken from a grave marked as an Unknown
British Soldier. The bodies were selected from the early years of the war,
so decomposition had taken place. Proof of Britishness was the wearing
of a British Army uniform. The remains were transported to a chapel at
Saint Pol near Arras. The bearers arrived at different times and were
immediately sent away so they would not know if their body had been
selected. Two British officers, Brigadier Wyatt and Lieutenant-Colonel
Gell, entered the chapel alone at midnight and chose one of the bodies,
each of which was covered by the Union Flag. The other bodies were
taken for re-burial, and the chosen body was transported, with due
ceremony, across the Channel on the British Destroyer HMS Verdun.
The funeral in Westminster Abbey took place on 11 November 1920,
with full ceremonial. The grave was filled with earth brought from
France. The French Unknown Warrior was interred the same day under
the Arc de Triomphe.
The burial brought back memories. A blinded veteran, Herbert
Thompson, described how the atmosphere was impregnated with mean-
ing, and the occasion brought back the most poignant memories. I felt
with my comrades almost ashamed that I had given so little, while he
who was sleeping by us had given all . . . I came to the Abbey glad that
I had been chosen from among so many, I went away sorrowing, but
with the message of hope in my heart (quoted in Quinlan, 2005a, p. 22).
This moving quotation draws out the best in memorialisation how it
stirs memories of the war and comrades who fought and died, yet also
looks forward to a better future. It is also interesting that a blind man felt
that he had given so little compared with the soldier who had died. This
shows the inherent contradictions in any war memorialisation; the men
who were maimed are not the ones who are remembered. In some way it
is thought that they have not contributed as much as those who died,
they are not as important as those who died; because they did not die,
they should not be remembered.
Commemoration in Leningrad
The siege of Leningrad lasted nearly 900 days. Around 670,000 people
died, a third of the population, with up to 8,000 in a single day mostly
of starvation. In the first winter of the siege, 19412, with temperatures
dropping as low as 40 C, the daily bread ration went as low as 125 grams.
Commemoration of the Great Patriotic War, particularly the siege of
Leningrad, started very soon after the Germans invaded in June 1941.
Lisa Kirschenbaum (2004) has described how, days after the Germans
invaded the Soviet Union, it was reported by the Leningrad Komsomol
(youth organisation) that efforts to chronicle the war had already begun.
Commemoration in Leningrad 179
Shortly afterwards, when the siege began, exhibitions started to take

place that commemorated the war. These exhibitions, in commemora-
ting the present, merged the personal and public lives of the people
taking part in the war. Personal effects, such as letters, diaries and
photographs, were used in these displays. The Komsomolskaia pravda
newspaper emphasised the importance, if not the necessity, of immedi-
ately commemorating life that becomes history. Visitors to the exhibi-
tions were encouraged to think of their lives in historic or mythic
terms. The materials used in the exhibitions included artistic works,
flyers and other documents relating to the defence of Leningrad,
materials that the organisers assumed would later be of great value
to historians.
The state played a central role in these commemorations, drawing on
personal stories and memories to encourage the citizens to see them-
selves as part of the bigger struggle. This is not a particularly Soviet
behaviour; all nations perform this kind of state control. Workers at the
public library began collecting published artefacts of the siege shortly
after it began in the autumn of 1941. The collections director, Vera
Karatygina, argued that every document they collected would enable the
people to realise and recognise the past. The group of workers who put
this collection together worked closely throughout the war, and all bore
the loss of friends and family. Karatygina deliberately merged personal
memory and public commemoration. Kirschenbaum (2004) describes
how Karatygina, in a 1942 talk at a library conference, discussed the role
of the propaganda posters, claiming that the posters roused the same
feelings of patriotism in everyone, and that they were an exact represen-
tation of how Leningraders lived during the siege. She wanted the
propaganda posters kept to help stimulate the personal memories of
the survivors. After the war, the photographs that had been collected
were published in a Russian book entitled Leningrad Under Siege, which
has recently been reissued and which provides a very visual account of
the siege. In 1943 an exhibition was presented displaying everything
from the guns used by the Soviets and captured German tanks to the
letters and diaries kept by the population. It even included a piece
of bread, demonstrating the size of the bread ration in the winter of
19412. This made the exhibition memorable to everyone, as it evoked
their personal memories, even if they had not seen the German weap-
onry at first hand. The museum, though it closed in the 1950s, reopened
on the same site in 1989, and focuses largely on the everyday objects
of the siege. It is still run by people who took part in the siege, who
are there to answer visitors questions; the personal commemorative
element is still present.
What are the psychological benefits

of memorialisation and commemoration?
In one sense people have always memorialised war. It is just that, over
time, we forget. The important wars at any given time are those where
there are living veterans, or where there are people living who remem-
ber the veterans their children and grandchildren. Once these people
die, then the wars they fought become less important, and eventually
irrelevant. That is one reason why we dont consider memorialisation
for wars such as the Crimean War in the 1850s; it is just too long ago,
even though 100,000 British servicemen fought in the war, and
around 20,000 died. It was fought at a time when the recording of
births, marriages and deaths was in its infancy. There were no death
certificates issued for those who died. There were no commemorative
services for the ordinary men who died no Remembrance Sunday or
Cenotaph. That is not to say that people did not have a need to
remember their loved ones, but life was cheaper then. Attitudes
towards people have changed. A few hundred years ago, individual life
was relatively unimportant. A woman might give birth to a dozen or
more babies, perhaps half of whom would survive to early adulthood,
and most would be dead by the age of 40 years. It was normal to lose
children. Life used to have a different value. We now assume that a
person should live until they are three score years and ten, as the Bible
suggests if not quite a bit longer, so if a person dies, or if a lot of
people die, we as the relatives and friends, and we as a society, consider
it more important.
A further reason why we now memorialise more than in the past is the
sheer scale of the deaths. During the First World War nearly 10 million
people, mostly soldiers, died in a few short years. The industrial revolu-
tion had given us the technology to kill in vast numbers. During the First
World War this was particularly represented by the machine gun.
Though this was around in some form or other since the US Civil War
in the 1860s when it was known as the Gatling Gun it was not very
efficient until Maxim patented his model. The Maxim machine gun,
along with the Vickers one on the British side, caused very many of the
casualties on the Western Front. The machine gun was much more
efficient than shelling, as up to one-third of shells did not explode
(creating problems for farmers on the Somme to this day), and those
that did tended to be more effective at causing psychological distress
to soldiers hidden deep inside bunkers than at killing at least in
comparison with the machine gun.
Memorials and commemoration in the defeated countries 181
Memorials and commemoration

in the defeated countries
In the defeated countries, memorialisation is difficult. There are far
fewer memorials to the World Wars in Germany than there are in Britain
and France, and the WWI cemeteries to the Germans are not given over
in perpetuity, unlike the British cemeteries, which effectively become
part of Britain but which remain part of France or Belgium. There are
far fewer cemeteries, with the German dead often buried in mass graves.
The Second World War was particularly difficult for the Germans to
commemorate. They were seen as the perpetrators, not only of the war
itself, but also of the atrocities associated with the war: the killing of
millions of Jews, homosexuals, Communists, gypsies and Soviet prison-
ers. There have been attempts to show that the Wehrmacht should not
have had the same war guilt as the members of the Nazi Party, but this
has had little success, especially when evidence emerged regarding the
role of the Wehrmacht in the killings in eastern Europe. Other attempts
have been made to expiate the ordinary Germans, whether soldiers or
civilians, as ordinary people who were as much victims of Nazi Germany
as others. Some Germans have claimed that the allied troops were
liberating Germany in 1945, but in fact the country continued to fight
until the very last moment. There were few mass defections and surren-
ders before the last few days.
The German experience demonstrates the important role of the state
in developing memorials and commemorative events. The German state
was destroyed in 1945 and the new states of East and West Germany did
not particularly want to look back on a war for which they were guilty.
Interestingly, even though there was an apparent complete break
between the old and the new states, inevitably the new states were run
mostly by the same ex-Nazi Party officials who had previously run the
country. These people only wanted to keep quiet; there was no cause to
commemorate, so the individual millions did not have a chance to share
in national mourning.
The Japanese have successfully managed to mourn their dead, though
not without controversy. Though they were subjected to unconditional
surrender in the Second World War, as was Germany, they were allowed
a continuation of the state in the form of the Emperor, Hirohito, though
he was forced to lose his godhead. The Japanese have a national memorial
to the dead of all wars, and the dead of the Second World War are
commemorated there. Ever since the war, there has been controversy
when high-ranking officials have attended to mourn the dead, such
mourning being seen as inseparable from the role of the nation in the war.
A detailed example: the Falklands War

Burnell and Jones (2005) have argued that, in order to understand
commemoration, we need to break down artificial disciplinary boundar-
ies and develop a research methodology that incorporates elements from
different disciplines. Karen Burnell is a psychologist, and Rachel Jones
is an historian. Together they discuss how both disciplines feed into our
understanding of private and public commemoration of the Falklands
War. They examine public commemorative practice through memorials
that, they argue, reinforce a socio-cultural public narrative of the con-
flict. They also argue (as I argue throughout this book) that the recon-
ciliation of traumatic memories occurs through the creation of a
personal narrative as an example of private commemoration. According
to Burnell and Jones, memorials and public commemoration in the
latter half of the twentieth century became examples of aesthetic post-
modernity, resulting from the rise of subjectivity and the end of the post-
war historical certainty. This arose due to a change in the perceptions of
war, from the just Second World War to many of the later wars in which
Britain has been involved, from Korea to Iraq and Afghanistan, where
the aims and purposes of these wars were far less clear and, for many
people, unjustified. According to Burnell and Jones, the Falklands is a
difficult case study, belonging to the just group rather than the unjust.
There are many memorials to the Falklands War. Just like those
commemorating the First and Second World Wars, they take many
forms from plaques to statues and are situated in different parts of
the country. They are not necessarily erected in response to grief and
mourning, but are, like any other narrative work, the result of more
complicated politically centred ceremonies and ritualistic behaviour . . .
Within these complex languages of mourning we see death as a patriotic
force, binding the individual with nation (Burnell and Jones, 2005,
pp. 23). They present evidence of this social narrative by using
examples of Falklands War memorials. One of these examples is the
Gosport Hard mosaic and ceremonial garden. On the twentieth anniver-
sary of the war, there was a dedication ceremony attended by Baroness
Thatcher, who was, according to the authors, a former political leader
attempting to reinstate and renegotiate the political spectrum of the
conflict within the discourses of commemoration, essentially all these
acts are framed by remembrances (p. 3). The authors note the import-
ance of the dead soldier being perceived as a hero and a militaristic
image, which are key components of most war memorials.
Further to this, the memorial at Gosport Hard forms a direct
link between the Falklands and D-Day. The two wars are aligned
The National Memorial Arboretum 183
geographically, which suggests that the viewer is being encouraged to

draw assumptions about the legitimacy of the two events.
The second example of a Falklands memorial used by Burnell and
Jones is the Sallyport plaque. This is engraved with an image of the
Falklands and the names of every British soldier killed (memorials never
commemorate the enemy). This memorial serves a different purpose
to the previous one; it is used as a site of pilgrimage by veterans
and families. Items such as personal notes and photographs are left
throughout the year, not just on Remembrance Day.
Burnell and Jones argued that the Sallyport memorial is used more
than the Gosport memorial because the latter is not part of the organic
narratives of memory that seek to commemorate the conflict (p. 5).
Instead, the Gosport memorial is an example of dominated memory,
one which does not have a personal touch and is not relevant to private
narratives.
The authors argue that memorials are complex texts or narratives
which are open, as any other social discourse, to interpretation and
reinterpretation by both veterans and mourners and wide public audi-
ences. In this way, individual memory is responsible for the hegemonic
public constructions of memory which may be utilised to reinforce the
established narrative. According to Burnell and Jones, memorials can
bridge the gap between public and private memory, and public and
private commemorations are joint endeavours, not mutually exclusive.
The National Memorial Arboretum

The National Memorial Arboretum (NMA) was created in the 1990s as
a site for remembrance (Childs, 2008). It consists of a large 130-acre
site, deliberately placed in the centre of the country, away from London,
for memorials and commemorative events relating to wars from the First
World War to the present day. It has become the site for the national
memorial to those who have died since the Second World War. This is a
poignant memorial as it contains vast spaces of stone, as yet uncut with
the names of those who have not yet died in the service of their country.
That is a change from previous memorials, which have only looked to the
past; this one looks to the future. In this way the NMA is a memorial not
only to the past, but to the present and the future, and is attempting to
be so through not only commemorative events, but also the education of
younger people.
The site has many memorials to battles, to units of the armed forces,
and to individuals. There are many trees planted as memorials, which
will, in the near future, create a memorial forest, with clearings for the
larger stone and brick memorials. It is interesting that it was thought

necessary to create a new site of remembrance and commemoration in
Britain, when nearly every town and village has its own memorial. Is
there a greater national need for remembrance, or is it that we are now
learning how to use remembrance and commemoration as an effective
means of educating future generations about the past? Instead of
memorials being inert and inactive, as many were becoming at the end
of the twentieth century, perhaps we now realise that commemoration is
not just about ageing veterans marching past the stones and flags, but
about helping younger people, and those without experience of war, to
understand something and to realise why we commemorate past wartime
events, and remember those who fought, i.e. it serves an educative pur-
pose. It certainly draws the experiences of war throughout the twentieth
century and beyond together at a single site, which inevitably makes it
more attractive to visit, not only to get a sense of remembrance for a
specific person or group, but also to understand the wider context of war.
Conclusions
Memorialisation and commemoration are experiencing a growth in the
West. It is difficult to determine whether this is because we are reaching
the endpoint of commemoration for the dead of the World Wars, with
most of the participants dead and the rest very old, whether it relates to
the breakdown of the nation state and an attempt by the nation state to
unify the nation again, and to draw on unknown reserves of patriotism,
whether it is a result of the increasing publicity of current wars and the
relatively large-scale casualties, or whether there is a psychological
need that has not been fulfilled in previous decades. It is likely that there
is a combination of factors. The state could not force individuals to
commemorate, and individuals, though they do carry out small-scale
memorialisation and commemoration, need the state to take part in the
large-scale events.
Memorialisation and commemorative events are yet another way of
demonstrating and creating narratives that are linked to the social dis-
courses of the time. Both memorials and commemorative events tend to
be public, and they tend to be aspects of a discourse that is accepted by
most people within the country. In reality, many people from families
who have immigrated to the UK in the last few decades may not feel
anything about such rituals they may not feel part of it but remem-
bering the dead of the World Wars and conflicts since then has become
an important part of remembering the history of Britain. It is almost
unheard of for groups to protest at a commemorative event. Anti-war
Conclusions 185
demonstrators do not demonstrate at the Armistice Day service, perhaps

partly because we have modernised the reasons for the service if not
the service itself; it is almost universally recognised as a series of events
that remember the dead, and does not glorify wars or victories. As the
Second World War generation dies, it will be interesting to see how
important these commemorations remain. There is an attempt to make
them valid for the more recent wars fought by our troops, but it is not
clear that the key commemorative events will remain in place for long, or
whether smaller, more individually focused events will take their place.
The social discourse moves on, and narratives follow.
13 Battlefield tours
This chapter is a little unusual in a book about the psychology of war. One
purpose of the book is to try and understand something about how
humans behave in response to war, with a special focus on exploring the
role of socio-cultural factors and memory. Peoples understanding of war
if they are lucky enough not to have genuinely experienced it is largely
derived from books, television and films. The aim of this chapter is to take
a more active approach than just reading, but one where the danger has
passed to walk around the battlefields themselves, in the footsteps of the
soldiers. In this way, one can improve ones understanding of war, and try
to understand something more of what people go through when they
fight. This is addressing the van der Kolk statement: the body keeps
the score. War trauma is about bodily experience as much as emotional
or cognitive factors, so walking the battlefields adds something to ones
understanding. The chapter does not provide the detail for specific tours,
but instead gives some guidance on how to organise a tour, and on how
what you put in to such a tour can enhance what you get out of it.
The chapter uses a single example: to Ypres, for Passchendaele. I make
no excuses for choosing this site. It has been described many times before
and is familiar to many people interested in war. Its woods and fields
have been trodden over by many thousands of people since the battles
took place. Many other battlefields could have been chosen, but I chose
Passchendaele for personal reasons: because my fathers cousin, Charles
Hunt, died there on 1 August 1917, and is remembered on the Menin
Gate. I know very little about him, as those who did know him are now
dead. Those I could have asked when I was a child I did not ask because
I was a child. My father, who was born the year after Charles died, was
named after him. My middle name is also Charles, so there is a clear link.
A brief outline of the battles

If you intend to do these walks, then you should do some prior reading,
and find out about what happened during the battles, and where
186
Passchendaele 187
important or interesting events took place. There are numerous excellent

books available about the battle.
Passchendaele
What Jerusalem is to the Jewish race, and what Mecca is to the
Mohammedan, Ypres must always be to the millions who have lost a
husband, son or brother, slain in its defence, and now sleeping their
eternal sleep within sight of its silent belfry.
These words were written by Lieutenant-Colonel Beckles Wilson,
the Canadian Town Major until October 1919, who was fanatical in
his desire to preserve the town of Ypres as a ruined memorial (see www.
cwgc.org/ypres/content.asp?id=38&menu=subsub). Fortunately for the
inhabitants, once he had gone, the town was slowly rebuilt as a copy
of its former self the houses, shops, churches and offices being built
from old plans, photographs and the memories of people. The centre of
the town is now an almost exact copy of how it was before 1914.
Virtually the only thing that had survived more or less intact were the
fortified walls of the town, built to Vaubans plans for defence against
very different artillery, several hundred years before.
The Battle of Passchendaele or, more formally, the Third Battle of
Ypres, took place between July and November 1917. The word
Passchendaele itself became a very emotive word in the English lan-
guage for several generations, through to the grandchildren of those who
fought there, providing evidence of the nature of cultural memory, i.e.
that it has a relatively short emotional life. Now, the word does not
convey the emotions to younger generations that it once had.
The site of the battlefield, extending several miles to the south, east
and north of the town of Ypres in southwest Belgium, was fought
over throughout the First World War. In 1914 it was the scene of
bitter fighting as the Allies and the Germans were involved in their
race to the sea. It helped to establish where the front lines were going
to stay for most of the war. By 1917, the soldiers who fought at the
Third Battle were fighting over ground that was already scarred from
shellfire and contained the bodies of many thousands of troops of
both sides.
The British, defending the salient around Ypres where there had been
little movement for nearly 3 years, planned to strike through the German
lines, cut off the occupied Belgian ports, and take Antwerp in the north
of Belgium. It was an ambitious plan and, as with so many ambitious
plans in this war, it was doomed to failure. In the end, the British
managed to take a few square miles of territory, the biggest advantage
being the Passchendaele Ridge itself, from where German artillery

observers had been targeting the British troops since the end of 1914.
The precursor to the main battle took place in April, when nineteen
mines, dug by ex-coal miners, were exploded under the German lines
along the Messines Ridge, causing havoc among the German troops. The
Allies quickly took the ridge, but advanced no further. Twenty-one mines
had been laid. One blew up in the 1950s; the other is still underground
somewhere, still charged with explosives, no doubt unstable after so
many years in the ground.
Charles Hunt was an ordinary Private with the Queens Royal West
Surrey Regiment. He came from Belper, Derbyshire, and had two sisters
and a large extended family. There was nothing special about him, except to
his family; he was just one of millions of men who joined up and fought for
their country between 1914 and 1918. In July 1917 he was behind the lines
somewhere near Ypres, perhaps spending time at Poperinghe, a favourite
town for soldiers who had a few days off, as there was an ample supply of
beer and girls, the two things a soldier most needs before he heads into the
fight and if he returns from the fight. In late July his battalion moved up to
the line near Hill 60, situated to the southeast of Ypres, just off the Menin
Road. There is a memorial there today, as at most of the important sites.
The battalion took part in the advance on the second day, 1 August 1917.
Charles Hunt advanced up the hill through Sanctuary Wood, so called
because in the early days of the war men could rest from battle among the
trees, but now it was in no mans land not a place of rest, but a place of
broken trees, filthy craters and intense danger, where many men took their
permanent rest around that time; Charles Hunt was one of them.
Charles was killed in that first advance. We assume and hope that his
death was a quick one, because his body was never found. We do not
know whether he died from being too close to an exploding shell and his
body being torn to pieces, or whether he died some horrific slow death,
with his body gradually submerging under piles of earth and mud.
Unless he becomes one of the many soldiers bodies now being dug up
by WWI archaeologists, we will never know.
Not knowing how their loved one died was always difficult for relatives
and friends. That is why the concept of the Unknown Soldier came about.
The Unknown Soldier was selected from all the unidentifiable bodies
of all the battlefields. No-one could tell who it was, and so it became
the symbol for all grieving families who did not have a grave to visit.
Charles Hunts name is inscribed on the Menin Gate, along with
nearly 60,000 others, all missing in action around Ypres. As there was
not enough space on the Menin Gate for the missing, those who were
missing after 1917 were inscribed on plaques on the walls of the nearby
The tour 189
Tyne Cot Cemetery, the largest on the battlefield, situated on the slopes
at the top of which is Passchendaele village, the main aim of the battle of
1917 finally reached after many months of fighting, and of which
nothing remained. The village now is completely rebuilt.
Visiting the Ypres area for the first time, you experience emotional
numbness at the sight of so many cemeteries containing the graves of so
many young men. The British graves are all of white Portland stone,
and the graves are all well tended, situated on land that has been donated
to the UK forever. It may help to imagine each stone as a man, returning
to the parade ground, to get a feeling for the numbers involved.
A tour of a battlefield when you are exploring the experiences of a single
soldier is, in many ways, more satisfying than visiting without such a focus.
While an understanding of the grand plan is developed, you learn little of
the experiences of war. Focusing on a specific individual and walking
the battlefield as though seeing it through his eyes provides a personal
perspective that gives a greater psychological understanding. Before going
to the site of the battle, read about what happened to the person, or to the
persons battalion if, as I did, you have little personal information about
the individual. Look at maps, try and trace the route the person took so
that when you are there you can follow that route and not the routes
specified by any tourist agency. Get the personal perspective.
Once at the battlefield it is important to visit the key sites and the
museums so that you can see the personal items carried by the soldiers,
the weapons used, but also the very personal things the letters, the tin
openers, the copies of newspapers, and the pictures of girlfriends. Again,
it personalises the experience and allows you to get inside the head of the
soldier. Personally, I do not like the modernisation of museums in the
Ypres area (and elsewhere). They distract from the experience. You can
look at a computer screen and see fancy animations and films anywhere,
but you can rarely see the individual items, the rusting guns, the uni-
forms, the personal equipment. The museums in the Ypres area vary
from a few piles of rusting junk to ultra-modern high-tech installations.
The preservation of memory for the First World War is undergoing
massive change; as the generations who knew veterans die, then the
events become history, not memories handed down through genera-
tions, something which ceases usually at the second generation.
The tour
Ypres itself is a good place to base the visit, though there are villages all
around where you can get good accommodation. The shape of the
battlefield makes Ypres the central focus. Take a good map of the area,
and mark it with the key sites of interest. This two-day tour uses both
walking and driving. There is no attempt to explore the whole battle-
field, as it is a personal tour, though I would recommend you drive
around the whole area just to get a sense of the size of the battlefield,
to see the perspectives of other soldiers, and to explore the monuments
and museums in other areas. The first day is spent around the area in
which Charles Hunt fought, and the second covers some of the key sites
of the battlefield.
Day 1: searching for Charles Hunt

Start in the centre of Ypres, by the Cloth Hall, rebuilt between the 1920s
and 1960s from the rubble that was all that remained after the First
World War, and walk out of the town by the Menin Gate, the route taken
by many thousands of men marching to the battle. We will return to the
Menin Gate later. For now, you cannot avoid seeing some of the thou-
sands of names of the missing, and the magnificence of the memorial.
A few hundred yards further on, turn right on the Menin Road. You walk
through the outskirts of Ypres, passing a British cemetery on the right. It
is often informative to visit the cemeteries you pass, and look at the
names and regiments. Most men were buried near to where they fell, so
cemeteries say a lot about the battles that took place. To get some idea
of the scale of death, imagine the men standing again. Look also at
the personal inscriptions at the bottom of many gravestones, the only
personal touch allowed to the families. While many have standard
phrases relating to religion, many have more personal touches.
The roundabout you approach when leaving Ypres is Hellfire Corner.
A small monument indicates the furthest advance of the Germans in
1918. Here the troops were subjected to enemy shellfire. The German
guns were trained on the corner, so large camouflage sheets were put up
along the road to hide the troop movements from the German spotters
on the small hills to the east and the south. Stay on the Menin Road
you will pass another cemetery on your right. The German frontline
trenches were situated across the hill in front in July 1917; while the hill
is not high, the Germans could see the British positions and movements
very clearly, and the British, Charles Hunt included, had to advance up
the hill into the German machine guns. It must have been very different
to the peaceful rural scene now. To the right of the road you can see
Sanctuary Wood, where you are heading shortly. Straight ahead, there
are the white headstones of Crater Cemetery, the stones of those who
died advancing up the hill.
The tour 191
Take the road to the right indicating Hill 60. You pass another, large,
cemetery on the right. You are then at the edge of Sanctuary Wood.
A little way further along is Hill 60 Museum, which is well worth a visit.
Inside is an array of stereoscopes, machines that are set up with hun-
dreds of three-dimensional photographs of the war. Many are quite
gruesome, men and horses dead. This gives a good impression of the
battlefield of the time. The museum also has many artefacts from the
war many displayed well, and others piled up rusting. Outside there is
an area of original trenches, some of which have been reconstructed,
including tunnelled areas. There are even some tree trunks remaining
which had been destroyed by shellfire. The trenches were British.
On leaving the museum, Hill 60 is on the right. Again, there are
memorials to see. Charles Hunt was positioned around here before the
battle started on 31 July. He would have seen the first troops advancing
up through the ruins of Sanctuary Wood towards the chateau at the
top of the hill occupied by the Germans. No doubt he, like most
others, was terrified of what was to come, but the soldiers supported
each other.
The next day Charless battalion advanced across the line of that taken
by the troops the previous day. Standing on Hill 60, they advanced
through Sanctuary Wood towards what is now Crater Cemetery. Now
walk up the path to the south of Sanctuary Wood. This opens out onto a
track, and then a road. Turn left. Look around and get an impression.
The slope you have just come up saw the deaths of many men. When you
are at the top you have reached the German lines, though very little now
remains. After a couple of hundred yards there is a track which heads
into Sanctuary Wood. Go down this and into the wood. When I first
walked in this wood alone I started to imagine the ghosts of the thou-
sands of men who had died here. Then I realised that these men were
fighting for my country and would be protective. The path leads straight
down through the wood to a track, where you turn right and head up to
the Menin Road. But while in the wood, it is worth exploring. It is in
places like this that you often get the best feel for a battleground, a place
that is relatively untouched and which still has traces of the lines of
trenches if you look carefully. But be careful, not every ditch is a trench!
It is also in places like this that you find relics of the war: bullets,
shellcases and, sometimes, intact shells complete with detonator and
explosive! If you do find a shell and they are quite common dont
touch, but report it to the police for disposal. I have found intact
shells up to 3 feet long, and they still look frightening. There was so
much ordnance fired in these battles, and so much of it was ineffective,
i.e. it didnt explode. There are still many tons to be found. And no
doubt more deaths. I found a large piece of shellcase just outside the
wood, splintered and twisted by its explosion. While it almost certainly
didnt kill Charles Hunt, there is some comfort in thinking that it did,
instantly.
Across the road there is a hotel, in the grounds of which are a number
of mine craters, now filled with water and forming a decorative feature in
the garden. For a small sum you can enter the area and explore. There
are other artefacts and the remains of a German trench, one that was
blown up by the mines that made these craters.
Turn right onto the Menin Road and walk down to Crater Cemetery,
so called because it was built on the site of a large crater, the shape of
which can still be seen at the top end of the cemetery. This is a large
cemetery, containing around 6,000 men. From here you can see why
they died. You are standing near the German front line, from where they
shot down onto the advancing British troops. It is here that I like to think
Charles Hunt is buried, one of the 2,000 or so unknown graves. I have
no idea whether he is here, but this view illustrates our need for a site of
memory to use Noras phrase, a place to mourn.
After visiting the cemetery, go to the museum across the road.
It contains a large number of artefacts, well displayed, and even partially
labelled. There is a good collection of shells of many sizes. There is also
a cafe.
After the museum, head back down the Menin Road towards the
British lines and Ypres. When you start to go uphill there is a crossroads.
Turn left and follow the road to the next village, Gommecourt. At the
end of the road there is another cemetery, on the site of an old tile
factory. Turn left (south) down the road and after a few hundred yards
turn right onto a small road which leads to the lake. The nearest part of
the lake is called Hellblast Corner, and was the area where Charles
Hunts battalion formed up before heading into the front line. Walk by
the lake (either side) and head back to Ypres. By the roundabout with a
large tap you can either go straight on, then turn left and follow the walls
back to the Menin Gate, though you can enter the town through an
earlier path, or you can turn left and enter by the Lille Gate, but we will
be returning this way tomorrow.
Before 8 p.m. you should be standing in the Menin Gate, probably
with hundreds of other people. Just before the hour the road is closed to
traffic, then several firemen of the town march up and play the Last
Post. It is a very moving ceremony, and has been carried out every
evening since the Menin Gate was finished in 1926 apart from the
years of occupation, 19404.
The tour 193
Ypres has a number of interesting restaurants and bars, and the local
beers are varied and flavourful. By the end of the day you may be in need
of several beers and a good talk about what you have seen.
Day 2: museums, memorials and cemeteries

The first part of the day involves visiting two sites away from Ypres, with
the afternoon spent in the town. Drive to Hill 62. When I first visited this
site there was an old cafe across the road, basically a shed full of bits and
pieces from the war. Now there is a smart modern cafe and the artefacts
have gone to an Ypres museum. Hill 62 is of interest because the area
was left largely as it was in 1918. It is a mass of shell holes, mounds and a
virtually intact British pillbox. The site demonstrates the value of actu-
ally walking a battlefield in a way different to that experienced yesterday,
which was on a large scale, where most of the trenches and sites have to
be imagined. It is not difficult to imagine Hill 62 as a battlefield. Though
it is now covered with grass, trees and brambles, take that away and the
shape is intact.
After Hill 62 drive to the Tyne Cot cemetery (named by the
Northumberland Fusiliers after a barn they called Tyne Cottage which
stood near a level crossing). If you choose your route carefully you can
take in other sites of interest from the battle. Tyne Cot Cemetery is
on the slopes of Passchendaele Ridge, not a high hill, but fought over for
the last weeks of the battle. Passchendaele village is at the top of the hill,
the final point reached during the battle. You will see that very few miles
were gained for the loss of so many troops over several months. The way
you enter the cemetery depends on your view regarding memory. The
old entrance, at the bottom of the hill the bottom of the Passchendaele
Ridge is the best. You enter the cemetery and immediately get an
impression of the size. This is the largest cemetery on the battlefield,
and the largest cemetery cared for by the Commonwealth War Graves
Commission. Not only does it contain nearly 12,000 graves, it also has
many panels of names of nearly 35,000 soldiers for whom there is no
known grave. In the end the Menin Gate was not big enough to contain
all the names of those lost without a grave.
You can enter the Tyne Cot Cemetery from the top, through the new
entrance opened by Queen Elizabeth. This entrance typifies the new
way of memorialising the war, with a modernist building and various
displays. Personally I see this as a distraction from the cemetery, but we
all commemorate in different ways. We will return to this topic below.
After the cemetery, go to the town of Zonnebeke, where there is an
interesting museum in the chateau. At the entrance to the park there are
old concrete sentry boxes. The museum itself has a range of good
displays, but the best part is the dugout. This is a reconstruction
of a WWI dugout, complete with various rooms fulfilling a number of
functions, from hospitals to officers quarters.
Return to Ypres. There are many walks and places to visit in Ypres. Just
wandering aimlessly around the town you will get a feel for the architec-
ture. The centre of the town does feel a little frozen in time due to it being
rebuilt in the pre-war style. The Cloth Hall is a magnificent building,
ruined by war and rebuilt over 50 years. The main museum is in here, but
take time to look at the building itself. Parts of the original walls remain,
but only the very lower parts. The museum itself is modern, and this is
where I have reservations. When I visited, there was a group of school-
children going around, but few of them were looking at the exhibits, the
artefacts of war. Most of them spent their time pressing buttons for
the computer demonstrations, something which they might as well have
stayed at home to do via the Internet. The modernisation of museums,
while there is an attempt to create a particular narrative of war, distracts
from the contemplation of the museum pieces themselves. This does seem
to reflect a trend towards accepting shorter attention spans and not
enabling visitors to learn about the war.
Walk down to the Lille Gate. Here there is a peaceful little cemetery
built as part of the town walls, where you can sit and contemplate, and
look out across the moat towards the south towards Hill 62 and the
Messines Ridge. Just by the Lille Gate is a bar and museum. Both are
excellent. They are run by a Belgian enthusiast, who is very happy to
discuss his museum project with visitors.1 The museum is at the back of
the bar. It contains many artefacts from the war, and the benefit is that
the owner is always thinking of new ways to display them. One memor-
able display has the visitor at the foot of the stairs of a dugout, and a
soldier who has been shot and has fallen halfway down the stairs.
After you have been in the museum, have a drink in the bar. They have
a special brew to commemorate the war and you can buy a beer jug to
remember your visit.
Creating your own battlefield tour

As you will have seen from the above, the concepts of narrative and
social discourse are very important for a battlefield tour. If you just turn
1
I recently visited Ypres (December 2009) and unfortunately the owner had died, aged
only forty-six. Currently, his wife is still running the bar and the museum is still open, but
not being developed.
Creating your own battlefield tour 195
up to where a battle took place, and wander round looking at the

memorials and the museums, you will get a feel for the battle that took
place, but if you want to get into the heart of the battle then you need to
do preliminary reading about the battle, and perhaps find something out
about specific individuals who fought there, not necessarily the generals
and commanders, about whom many people will have written, but about
some of the ordinary soldiers who fought about their experiences,
thoughts and feelings regarding the battle. The people who fought
in the First and Second World Wars left numerous accounts of their
experiences some published as books, some available as diaries on the
Internet, and many at archives such as that of the Imperial War Museum
in London, which has recorded the experiences and memories of many
participants.
When learning about a particular individual, or even about a particu-
lar unit, it is valuable to follow in the footsteps of where he fought, get a
feel for the territory, and see where he was positioned and where the
enemy was positioned. Where possible, retrace his movements. If you
are aware of the names of the dead perhaps a relative, perhaps a friend
of the person whose story you are following visit the grave. It can be
more moving to find a single grave than to take in the enormity of so
many dead. If it is the Commonwealth War Graves Commission, then
there will be a book that lists the dead in a box at the cemetery entrance.
This book can provide interesting information about the dead: where
they were from, and their parents names, which gives it a personal
quality. There may be other personal elements. When visiting a cemetery
near Amiens, my father was sitting at the entrance to the cemetery,
looking through the book, when he came across the name of a family
he knew from his village, the Elliots, whose son was buried there. This
was an enormous coincidence in the circumstances; he had no idea
where this soldier was buried. He just had a recollection from when he
was a child of the family who had the missing son.
But why, you may ask, is this chapter in the book? What has it to do
with narrative and social discourse? It is here to show how our under-
standing of war, how our memories of war, how the history of war, can
be better understood if your interest is made personal. I have trodden on
many battlefields, from the English and US Civil Wars, to the First and
Second World Wars, to Bosnia, and each time I have gained a better
understanding of the battle, a more personal understanding of what it
means to soldiers who fight.
14 Conclusions and future directions
This brief chapter draws together the material that has been examined
through the book, identifies some key themes relating to memory, war
and trauma, and proposes a framework for future research. In the end
the purpose of research in this field has to be helping those who have
suffered psychologically due to war or other traumatic events. This book
has not looked at psychological therapies in any detail, because that has
not been the purpose of the book, but it is hoped that clinicians and
therapists will find valuable lessons for therapeutic practice within these
pages. We do now understand a great deal about war and the psycho-
logical impact war can have on people. The introduction of PTSD in
1980 provided a useful impetus for research, and there are now well over
20,000 academic papers published on this topic. While they do, of
course, vary in quality, overall it has meant that we have a much better
grasp of the key issues surrounding war trauma.
What have we learned?

This book has demonstrated, I hope, that a good understanding of
memory, war and trauma requires more than psychological research.
War is a topic that affects most people in one way or another, whether as
active participants, a family member of someone in the armed forces,
students of history or someone exposed to the media.
Interdisciplinarity
Throughout the book the discussions have been largely about the
importance of interdisciplinarity. This is currently a trendy word in
academia, and trendy is not necessarily either interesting or pertinent,
but within the area of war trauma interdisciplinarity is invaluable. As we
have seen, we cannot fully understand the nature and effects of war
trauma without drawing on the expertise of researchers in a number of
disciplines, including not only psychology but also sociology, history,
196
Narrative 197
political science and literature. And it is not just academics who are
making the contribution it is novelists, poets and biographers, people
who think about and write about war. Without their contribution, most
of us would know little about war.
In order to understand an individuals memories of war and the
impact they have on behaviour, we have to look beyond the individual
to wider society, social constructs, politics and history. What I hope has
been made clear in this book is that we gain a more coherent and
complete understanding of war trauma through a thorough study of
these different areas. The chapter on literature, with the focus on
Remarques All Quiet on the Western Front, was an attempt to show
how literature can contribute to a psychological understanding when
the literature itself is seen as data. Remarque (1929) experienced the
trenches of the Western Front first hand, and so was in a good position to
write about what they were like, drawing on the freedom of a novelist
to arrange and present complex ideas about the impact of war experience
on people. The book is not only a psychological account; it is also
presenting an account of the culture in WWI Germany.
Literature is a rich source of narrative psychological understanding,
and psychologists should be encouraged to read more. Good novelists
are also good psychologists, as characters have to be strong and well
rounded. The interactions between the characters in a good novel are
necessarily psychologically insightful; they are telling the story of the
human condition. Psychologists who sneer at the psychological insights
from literature are missing an important point about science: science is
not about the methods used; it is about increasing systematic knowledge
and understanding about ones subject. The experimental method might
be very helpful at helping us to gain insight, but so is reading Dostoevsky.
Narrative
The key argument within the book has been the centrality of narrative
to the human condition. Without narrative we are nothing. Without
narrative we cannot understand either the personal or the social world.
It has been argued here and elsewhere that humans are essentially
storytellers, and we have a whole range of stories that we use, stories that
we tell our families, stories for our friends, stories for our professional
lives and stories we tell ourselves. One of the wonderful things about
being a person is that we can manipulate our memories more or less
at will though often such manipulations are implicit or unconscious.
Depending on the audience, we can remember certain events about
the past and conveniently forget or omit others, depending on the
impression we want to make on other people. Sometimes these narra-

tives are explicit we deliberately present a certain image of ourselves,
for instance in a job interview or when trying to chat up a member of the
opposite sex. At other times we unconsciously project an image of
ourselves to other people, and the narrative is more implicit. As we get
to know people our narratives develop and change according to the
relationship we have with the person. The social one is nearly always
involved, as a narrative needs an audience. The only exceptions, and
they may not be exceptions, are the narratives we tell ourselves about
ourselves, but again, how we wish to project ourselves will still, in the
end, feed our social narratives.
In one sense being traumatised, being unable to form a narrative,
reduces someone to something less than a person because the trauma-
tised person cannot tell the story of their experiences. This is disorien-
tating and depressing for the person because they cannot make sense of
what happened to them. It is important that we, as professionals, find
ways of helping people to recover the stories of their lives. We develop
and use narratives in different ways, and this should be acknowledged for
war veterans. Cognitive behaviour therapy is not for everyone; it suits
people who can be helped to resolve their trauma. For many people, the
sophisticated use of language and thinking skills that is required is not
available. The Normandy veteran who writes poems to resolve his trau-
matic thoughts may not necessarily desire that the narrative of the poem
is read by anyone, but the poem is certainly a narrative. The veteran who
does not have the cognitive skills or motivation to write may not be able
to find an appropriate audience social support to enable the narrative
to be expressed.
Social discourse
Narratives are not only developed through an internal focus on memories
and the ways these are structured; they are developed, as we have seen,
through interpersonal interaction and through internalising and interacting
with social discourses. Narratives do not develop in isolation. If we are to
understand why people think as they do, we have to look around them at the
world in which they live. No man is an island is very true for us all. The
way we think, what we believe, how we express emotions, all depend on our
culture. This has important implications for memory, war and trauma, as
memories are constructions, and such constructions depend as Bartlett
(1932) showed with The War of the Ghosts on the society in which
we live. A person traumatised by war is traumatised via the culture in which
he lives, and any treatment or therapy for trauma must take account of that.
History and memory 199
Universality and cultural specificity

Throughout the book there has been a theme of how psychologists
should attempt to differentiate universal and cultural aspects of thought
and behaviour. With respect to war trauma, we know that people in
different societies react in different ways to traumatic events that
PTSD may not be relevant to non-Western, or even non-United States,
societies. But we are also aware that some of the symptoms are universal.
The difficulty is that we do not yet understand which elements are
universal. It is proposed here that the narrative is the key universal
element, the need or drive to make sense of the world that is at the heart
of what it is to be human. Traumatic events shake and break our
understanding of what the world means, and resolving trauma is about
learning to integrate the traumatic memories into the world view.
The two coping styles, avoidance and processing, are universal ways
of dealing with problems. Nearly everyone makes use of both strategies,
but perhaps the majority use avoidance for most of the time. The work of
Horowitz and Creamer is seminal in developing our understanding
of how processing and avoidance interact and provides us with the
fundamental underpinnings of the trauma response. Social support is
also a universal; while different cultures may use social support in
different ways, people in all societies depend on each other.
The cultural elements are concerned with the nature of social support,
the contents of memory, specific coping styles and the specific means of
resolving traumatic stress. These have been little studied, and need a great
deal of further work. Unfortunately most research has made the assump-
tion that PTSD is a universal phenomenon, and focused on that, instead
of finding ways to separate out the universal and cultural factors. Coping,
though there may be universal styles of processing and avoidance, takes
different forms. Research with Iranian and Iraqi veterans of the IranIraq
War shows that these veterans are more likely to use religion as an
important means of dealing with their problems than people in the West.
The centrality of religion suggests a fatalism on the part of the veteran,
who fought the jihad for god, and puts his faith in god to always do what is
right. These veterans tend not to have the individualistic view of many in
the West, but an ideal of the collective, where the individual matters less.
History and memory

Memory and history do not conflict in the way that Pierre Nora has
proposed, but they have a chronological and psychological development
from one to the other. As the people who lived through a particular
period die, memories become the past and then the collective memories
are reinterpreted into history (then some events and objects of the past
are translated into heritage and become enshrined and unchanging, but
that is not central to the current discussion). In this way, we see how
memories fade, not just through the individuals who experienced signifi-
cant events, but also through their children and grandchildren who
have their own versions of the memories of those times, partly because
they grew up with hearing about the events, partly because parently
behaviour may have been altered by living through the events, and partly
through the surrounding culture, which remains affected by significant
events for many years.
This can be linked to memorialisation and commemoration. We
memorialise to remember, but memorials are stone. Commemorations
make memorials human, and enable us to recall the past. With regard to
the World Wars, until now such commemorations have been attended by
participants and their families; now most participants are dead or very
old. If such commemorations are going to be helpful, they need to also
look forward. One thing humans have been very bad at is learning from
the past. Each generation repeats the mistakes of the previous one. If we
listen to our elders it is to eventually ignore them. For instance, in the
Balkans there have been major wars for most generations for many
hundreds of years. (Ivo Ilich, 1916, 1994 The Bridge Over the Drina
illustrates this very well.)
We are perhaps at a turning point in our understanding of the role of
commemoration, and may be moving from a position of looking
back to looking forward with the past at the forefront. The National
Memorial Arboretum at Alrewas, near Lichfield, is not only a site
containing many memorials commemorating past battles and armed
forces units; it has an explicitly educational focus, and it is also a
meeting place for veterans groups. We may well be, in the Western
world, undergoing a fundamental revision of the ways in which we
interpret history and memory. We are now approaching the point when
everyone who experienced the World Wars is dead. Will we continue to
have a need to commemorate these wars in the ways we have done in
the past? What sense is there in such commemorations for people who
did not live through the wars? If commemoration of war is going to
continue, then it is likely that it will start to take different forms. The
educative function mentioned above is likely to be critical here, and will
necessarily bring together people from a range of disciplines who are in
a position to teach younger people about war, memory and history.
It will certainly not be the sole responsibility of historians; it will
become the preserve of others such as psychologists, cultural theorists
Beyond memory, war and trauma 201
and sociologists. Furthermore, the ceremonies at the Cenotaph and

elsewhere may also change. Many people feel that a strongly religious
service is inappropriate, as is a service that is seen as nationalistic. The
Germans lost millions of people in the war; so did the Russians and the
Japanese. In an increasingly globalised world, a smaller world, we need
to recognise the losses faced by all the participants in war, to stop
glorifying our victories and instead focus on the human suffering
caused by war.
Treatment
While treatment has not been a key focus of this book, it is hoped that
the contents will be useful for clinicians of various perspectives when
dealing with war trauma. It is clear that something more than clinical
skills is needed for a war veteran. The clinician must have an under-
standing of the historical period of the war the battles and politics
involved which all add towards an empathic understanding of the
persons experiences. Beyond that, the clinician should have an under-
standing of the role of narrative and social discourse, both as part of
normal psychological life and as a key part of the way in which a person
thinks and acts as a response to a traumatic event. Explicitly or impli-
citly, narrative development must play a key role in the resolution of
traumatic memories.
Beyond memory, war and trauma

I hope that the insights gained from developing a broader understanding
of war trauma will encourage others to look at how psychologists can
increase their understanding of different topics by drawing on under-
standing from other disciplines and from the world around. Memory
itself is such a big topic that its study should not just be in the hands of
people who work in psychological laboratories. Memory is not about
learning lists of numbers; it has a huge social and cultural function, and
whenever there are technological or other changes in society, we should
be looking at how the nature of memory changes. When printing was
invented, it meant that people no longer had to have epic poets to
remember the history of society; the information was written in books.
Now that the Internet has arrived, perhaps we no longer need to remem-
ber which books contain which information; we just use a search engine.
These changes have an impact on memory, and they are social and
cultural events.
Developing the narrative method

It is clear that we should incorporate narrative more centrally as part of
our psychological theories, but we also need to develop narrative method
further. Narrative is not well developed within psychology, but it is well
developed in linguistics and other areas. The work of Karen Burnell in
Chapter 9 showed that we can use narrative in a sophisticated and yet
psychologically meaningful manner. There is an urgent need to develop
these methods further and to find ways in which we can draw together
narrative and other methods, including quantitative approaches. We
have to develop theory and method together to identify and code narra-
tive constructions, identify the significant elements of narrative, and use
these to determine and predict a persons recovery from trauma.
Future directions
This is an exciting time to be interested in war trauma research. The area
has matured over the last couple of decades, drawing on the theoretical
work of psychologists who have displayed an interest in the area for more
than a century. There is a sense that an integrative understanding of the
processes biological, neurological, behavioural, cognitive, psycho-
dynamic, humanist, social and cultural is now possible. It is possible
because war trauma presents a practical problem that has to be dealt
with, and once professionals get their hands on a practical problem, they
will find the means of dealing with it irrespective of personal perspective;
so the cognitivist clinician makes use of behavioural understanding, the
humanist uses cognitive behaviour therapy, and the psychodynamic
practitioner recognises that there are occasions when a traumatised
person needs drug therapy. The more open-minded therapists take this
eclectic approach, drawing on the expertise developed over many years
by practitioners in other perspectives.
This then leaves the scientist with a job to do, integrating the work of
these multifaceted perspectives and learning to understand how they fit
together. And in order to do this the scientist must draw on a range of
methods. The experimentalist must now apply qualitative techniques,
and the qualitative practitioner must learn the benefits of quantification.
But this is all within psychology. We are now at the start of something
bigger. Within academia there is now a push for interdisciplinary work,
for academics within one discipline to draw on the skills and expertise of
academics in other disciplines who have very different theories, methods
and even language. The work on war trauma is open to this interdisci-
plinarity. As already discussed, if we want to fully understand the
Future directions 203
interrelated concepts of memory, war and trauma, we must look to other

disciplines: to history, sociology, art and literature.
For me, the key paradigm shift in psychology is the turn to narrative
described by Bruner. This shift, though far from complete, is having a
profound effect on psychological theory and method. It is early days yet,
but the area of narrative is changing the nature of the discipline of
psychology. From the experimental cognitive science of the post-war
period, psychology has undergone profound change, and much of it
is political. Cognitive experimentalism has given way to neuroscience,
which is obtaining the necessary funding to develop a more sophisticated
understanding of the neurological underpinnings of psychological
theory. Traditional experimental social psychology has given way to a
more sophisticated set of approaches largely qualitative and partly
drawn from other social sciences. There is a clear rift between these
two elements of psychology, though a full understanding of the mind and
behaviour requires both.
Narrative offers a means of integration, a way to bring these two
extremes of psychology together. Accepting the need for a narrative
understanding of memory, war and trauma means that we must draw
on neuropsychological understanding, as well as on traditional cognitive
and social theories. As mentioned earlier, we are, in psychology, only just
beginning to make use of narrative approaches, but these approaches are,
and will be, fruitful. At the moment our understanding of the neurological
underpinnings of narrative is negligible. The limited methods used
by neuroscientists, plus the problems associated with defining the com-
ponents of narrative, make it very difficult to understand the brain
mechanisms associated with narrative. It is likely that this understanding
will grow as we address practical problems such as war trauma.
The advent of narrative and other new methods within psychology will
enable us to approach our research questions from a cultural as well as a
brain science perspective. The majority of psychological theory has been
established in the West, using western methods and western perspec-
tives, with assumptions made about the universality of such processes. In
fields such as trauma, we are starting to acknowledge the range of
responses that people have, and how these responses are not just the
result of universal psychological processes, but also that they depend in
part on the cultural background of the researcher, the participant, and
the body of work the researcher draws on to derive their research
questions and methods. Even the term western is a misnomer, as it
generally refers to Anglo-Saxon psychology, not even accounting for the
varying philosophies and perspectives within Europe perspectives that
have much to offer in the understanding of war trauma.
We may also be at the point where we are going to change the nature of
commemoration. Throughout the twentieth century, commemoration
related to the World Wars. Once the participants are dead, and the
memories of these wars fades into the past and into the history books,
we will have to question why and how we use commemoration. What is
the purpose of 11 November? Why do we continue to parade in the
streets? Is it appropriate to make these events militaristic? I do not have
the answers to these questions, but it is certain that there will be changes
and, as discussed above, the changes will have to take account of what it
is that we want to suggest to the younger generations about war and
remembering war. Up to now, commemoration of the World Wars has
been a way of letting veterans know that we remember what they did,
and that the difficult and traumatic memories they might have are not
forgotten. This, in itself, has been of personal benefit to thousands of
veterans. Once these people are dead, can commemoration take on a
new role and be educative?
Of course, we still have people dying in what, to us outsiders, are
smaller wars, but to the participants are just as important as any war of
the past. People are endangered, wounded, maimed and killed. Friends
are lost and hardships endured, and still in the cause of the nation, or
the greater good. The difference is that these wars are irrelevant to
most people in the UK. They are minor sideshows that make for pub
arguments and good TV, but they do not affect most of us. Why should
we commemorate the dead of these smaller wars? We will not commem-
orate them in the same way as those of the World Wars simply because
they do not affect us all. There is no total war. Nevertheless, these
participants should not be forgotten, and their actions on behalf of the
nation should not be forgotten, but if we are to remember them, it has to
be in a different context to the current ceremonies.
Finally, this book has been concerned with memory, war and trauma,
specifically with the effects of war on veterans and on others who take
part. Instead of just focusing on the psychological problems that veterans
face the PTSD, anxiety and depression, the alcohol and drug abuse,
and the problems relating to families and work I have tried to take a
much broader perspective and show how veterans live in a social context
and have narratives about their experiences that derive, at least in part,
from that social context. I have tried to show, without providing any
specific techniques, how clinicians may benefit from drawing on this
broader perspective in their treatment of war veterans. Wars can deeply
affect societies, and it is important, if we are to understand how we
remember wars, to take into account the broader perspective, to show
how memory works in the social and collective senses, and how
Future directions 205
memories are transmitted and changed through generations. I hope this

book has given the reader pause for thought, as it has swept through this
broad range of subjects, areas that are at once disparate and brought
together by the study of memory, war and trauma.
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Index
Achilles 14 Baars, J. 120

Adler, A. 116 Babington, A. 19, 25, 123
Adjustment disorder of adult Baddeley, A. 75
life 51 Baerger, D. R. 129
Afghanistan 54, 144 Baker, S. L. 18
Age of Reason (Sartre) 82 Balkan Wars 109
Aggression 11, 57, 59 Bamburg, M. 43
Aging 1401 Barbusse, Henri 105
Alcohol 11 Barclay, C. R. 69
Aldwin, C. M. 140 Barker, C. R. 164
Algerian War 110 Barker, Pat 20, 105
All Quiet on the Western Front 19, Barrett, T. W. 155
16371 Barrs, J. 159
Amdur, R. L. 57 Bartlett, Frederick 69, 116, 118,
American Psychiatric Association 8, 9, 51, 126, 198
52, 56 Battle 10, 16
American Psychological Experience 1645
Association 92 Battlefield tour 13, 18695
Amir, A. 84, 87 Designing 1945
Amygdala 29, 72, 73 Battle fatigue 11, 25, 50
Anderson, C. 26 Battle neurosis 11
Androutsopoulou, A. 131 Battle shock 123
Animal studies 72 Beliefs 10, 62, 64
Anthony, J. L. 57 Shattered 12, 62, 71
Anxiety 11, 56, 57 Belief systems 67
Apologising 19 Belief systems breakdown 10
Apartheid 109 Belmarsh 12 54
Appel, K. E. 23 Belmont Hospital 24
Ardila, A. 76 Belper 188
Armistice Day 104, 185 Benowitz, L. I. 76
Arousal, increased 53 Bereavement 91
Assumptions 62 Bertaux, D. 45
Asylum, mental 19 Bible 14, 117, 180
Atkinson, P. 45 Bilsky, W. 121
Atrocities 10, 1478 Blair, Tony 19
Attention 61, 74 War criminal 19
Bias 61 Blessings 82
Autobiography 119, 125 Blitz 23
Autobiographical memory 4 Bluck, S. 131
Avoidance 7, 8, 9, 10, 20, 53, 57, 63, 656, Bolton, D. 62
67, 69, 78, 149, 1545, 157, 162, Bomber Command 26
168, 170, 199 Bonke, B. 34
222
Index 223
Bonne, O. 72 Civil War (Spanish) 25, 117, 156

Bornat, J. 120 Civil War (USA) 17, 71
Bosnia 5, 11, 85, 110 Civilians 1112, 23, 59
Ethnic cleansing 120 Classical conditioning 26, 67
Rapes 38 Client-centred psychotherapy 87
Bradshaw, S. L. 78 Clifford, Major Henry 17
Brain imaging 335 Clinical assessment 41
Brain scanning 29 Clinician 41, 50
Bramson, L. 140 Clipp, E. 86, 141, 168
Braun, A. R. 76 Cobley, E. 161
Bremner, D. 34, 53, 63, 72, 73, Cognitive Behaviour Therapy 31, 32, 55,
93, 119 198
Brett, E. 63 Cognitive processes 61
Breuer, Josef 17 Cognitive processing, 64, 65, 116
Brewer, W. F. 70 see also processing
Brewin, C. 62, 68, 70, 117, 119, Cold War 122
136, 139 Coleman, P. 116, 127, 129, 140, 159
Bricklayer 44 Collective memory 56, 97, 98, 99, 103,
British Army 142 1056, 200
British Empire 1245 Nature of 1056
British Expeditionary Force 25 Collective unconscious 1056
British Psychological Society 70 Combat exhaustion 25
Code of Ethics 45 Combat exposure 140
Bruner, J. 116, 139, 203 Combat fatigue 11
Bryant, R. A. 62 Combat neurosis 50
Buchenwald 153 Commemoration 13, 102, 104, 17285,
Buckley, T. C. 57, 74 200, 204
Buddhism 37, 82 Commonwealth War Graves Commission
Burnell, K. 42, 116, 127, 182, 202 1756, 193
Butler, R. N. 94, 141, 155 Communism 111, 122
Comorbidity 50, 56, 57, 59, 140
Calais 95 Computed Axial Tomography (CAT) 33
Calhoun, L. G. 84, 87, 88 Comradeship 11, 77, 144, 150
Cannon, W. 7 Concentration camp 99, 118
Cardiovascular system 74 Conditioned reactions 69
Carlton, C. 111 Conditioning 32, 71
Case studies 29, 41 Confabulation 118
Casualties 12 Confounding variables 30, 32
Causality 34 Confucious 81
Cenotaph 1767 Connerton, P. 112
Cerebral cortex 72, 73 Consciousness 63, 77
Challenger Disaster 120 Constructive Narrative Perspective
Charcot, J. M. 17, 21 (CNP) 92
Charge of the Light Brigade 16 Content analysis 41
Charles I 112 Control, personal 11
Charles II 111 Control variable 30
Chemtob, C. 69 Cook, J. M. 140
Child sex abuse 117 Coping 8, 16, 35, 65, 789, 96, 116
Childhood memories 116 In All Quiet on the Western Front
Children 12 16870
Christianity 82, 88, 117 Dissociation 63
Christianson, S. A. 73 Long-term 1525
Civil war 110 Post-war 1512
Civil War (English) 12, 11112 Strategies 54
Civil War (Guatemala) 118 Corbin, J. 41, 164
224 Index
Cortisol 34 DSM-IV 9, 52, 56

Counterfactuals 70 DSM-IV-TR 9, 52
Courts martial 123 Dunkirk 123
Coward 18, 19 Durkheim, E. 173
Craiglockhart 20, 161 Duty of care 48
Crater Cemetery 190, 192
Creamer, M. 64, 65, 69, 78, 170, 199 Earthquake survivors 140
Crimean War 16, 17, 18, 180 East Germany 111
Cromwell, Oliver 112 Political prisoners 62
Cromwell, Ralph Lord 102 Eberly, R. E. 74
Crossley, M. 42, 116 Eco, Umberto 171
Culture, non-Western 37 Ehlers, A. 62
Cultural memory 13, 121, 173 Ehrlich, P. 141
Cultural perspective 96 Einhorn, B. 111
Elder, G. 86, 141, 168
Da Costa, J. M. 17 EMDR 31, 55
Dalager, N. A. 54 Emery, O. B. 76
Dalgleish, T. 117, 119 Emery, P. F. 76
Daly, R. J. 16 Emotion 62
Dambusters 106 Emotional images 67
Davidson, J. R.T. 147 Emotional involvement 48
Davis, C. J. 70 Emotional numbing 7, 9, 17, 53, 63
Dayton Agreement 110 Emotional processing 32, 68
D-Day 182 Empathy 48
DeDous, J. F. 73 Engdahl, B. E. 74
Defence mechanisms 77 English 96
Dehumanisation 170 Epic poet 100, 115
Dependent variable 32 Erichsen, J. 16
Depersonalisation 63 Eriksen, E. H. 94, 141, 167
Depression 11, 12, 56, 57, 58, 59 Ethics 12, 28, 31, 33
Depressive rumination 66 Codes 28, 45
Derbyshire 102 Medical 31
Derderian, R. L. 109, 110 Procedures 312
De Silva, P. 37 Ethnic cleansing 66
Detachment, feelings of 53 Evolutionary 7, 61
Diagnostic classification system 50 Execution 18, 19
Diagnostic criteria 52, 57 Existentialism 778, 81, 82, 87, 88
Diana, Princess, death of 120 Experiment 323
Dickens, Charles 16
Discourse analysis 42 Falaise 153
Dissociation 14, 624, 140 Falger, P. R. J. 75
Peri-traumatic 63 Falklands War 117
Dissociative identity disorder 63 Memorialisation 1823
Distress, causing 467 False memory 70
Dollard, J. 27 Faradism 21
Dorsolateral prefrontal cortex 75 Fatalism 16, 149
Dostoevsky, Fyodor 197 Faulkes, Sebastian 105
Dreams 106 Favorini, A. 98, 107
Dresden bombing 87 Fear conditioning 72, 73
Drug treatment 24 Fear image 67
DSM 8, 36, 51, 58 Fear memory 67
DSM-I 51 Fear network 68
DSM-II 51 Fear response 65
DSM-III 9, 51, 56 Fight or flight 63
DSM-III-R 9, 52 Figley, C. 48
Index 225
Fisler, R. 66, 68, 69, 139, 162, 170 Habermas, T. 131

Flashbacks 14, 53, 71 Halbwachs, M. 99, 1056, 121
Fletcher, P. C. 75 Hanley, L. 161
Foa, E. 53, 57, 65, 68, 119, 150 Hanoi Hilton 93
Foley, M. 174 Hargreaves, G. R. 156
Folklore 1078 Harvey, A. H. 61, 62
Fontana, R. 86, 140 Hassan, J. 156
Forced march 95 Health and safety culture 49
Foy, M. R. 64 Heart disease 93
Fragments 118 Hellblast Corner 192
Frankl, V. 83, 88, 163 Hellfire Corner 190
Frans, O. 54 Henry IV Part One 15
Fransella, F. 91 Henry VIII 97
Freeman, M. 118 Heritage and commemoration 1745
French army 82 Heritage industry 102
Freud, Sigmund 17, 23, 25, 77, 116 Heritage society 102
Seduction theory 77 Herman, J. 9, 58, 77, 117
Fromholt, P. 155 Herodotus 15, 98
Frontal lobe Hesnard, A. 18
And narrative 75 Hibberd, D. 21, 162
Fuster, J. M. 75 Hierarchy of needs 82, 87
Future lost 1668 Hill, J. 62
Hill 60, 188
Gall, Francis 34 Museum 191
Garcie Effect 67 Hill 62, 193
Gardner, R. A. 63 Hinchman, H. 122
Geary, P. J. 100, 1078 Hinchman, S. 122
Gekenyi, M. 59 Hippocampus 29, 34, 72
General Health Questionnaire (GHQ) 142 Volume 34, 72
Gergen, K. 115 Historians 6
Gergen, M. M. 115 History 3, 6, 44, 97, 99, 173
German enemy 122 And memory 199201
Glencoe 174 Hitler, Adolf 5, 84
Glenn, C. 130 Hysterical blindness 24
God 88 Hobsbaum, E. 1078
Goenjian, A. K. 140 Holocaust 45, 83, 98, 104, 118
Goldberg, D. 142 Child survivors 87
Gommecourt 192 Holman, E. A. 63
Government, attitudes towards 144 Holmes, E. A. 68, 70, 119
Graesser, A. C. 120 Holmes, Oliver Wendell 17
Graham, B. 110 Homeostasis 7
Graybeal, A. 115 Homer 14
Graylingwell Hospital 26 Horowitz, M. 40, 51, 64, 78, 142, 199
Great Fire of London 15 Horst, R. 68
Greek tragedy 82 Horwitz, A. V. 52
Greening, T. 78 Hough, L. B. 76
Grounded theory 41, 164 Humanism 778, 87
Group conflict 122 Hunt, Charles 186, 1902
Growth, personal 77 Hunt, L. 141
Assessing 845 Hunt, Nigel 40, 59, 65, 74, 79, 84,
And psychotherapy 87 116, 127, 140, 142, 160, 162,
Guernica 117 164, 168
Guidano, V. F. 91 Hutton, P. H. 1012
Guilt 1467 Hyperarousal 7, 9, 57
Gulf War Syndrome 136 Hypochondria 74
226 Index
ICD 8, 36, 51, 58 Knox, M. 1078, 174

Identity 1011, 11516, 132 Kolodner, K. 54
National and group 172 Korean War veterans 142
Iliad 14, 170 Kosovo Polye, Battle of 109
Illich, I. 200 Koss, M. P. 70
Impact of Event Scale (IES) 40, 142 Krook, D. 163, 170
Independent variable 32 Kubany, E. S. 147
Informed consent 46, 47 Kuhnian paradigm shift 21, 34
Insulin treatment 25
Interdisciplinarity 6, 43 Labour Party 84
Interdisciplinary 13, 80, 118, 1967 Lack of moral fibre 26
Interpretative Phenomenological Analysis Lang, P. J. 67
(IPA) 42 Language structure 120
Interviewer 43 Last, R. W. 164
Training 48 Learning theory 678
Interviews 2930, 413, 142 LeDoux, J. E. 72, 73
Analysis 412 Lehman, D. R. 70
Saturation 42 Leningrad 1789
Themes 42 Siege of 178
Transcription 42 Lennon, J. J. 174
Intrusion 10, 40, 65, 140 Levine, S. 7
Intrusive recollections 7, 52, 1458 Levinson, M. R. 140
Intrusive re-experiencing 9, 57 Levitt, H. 90
Intrusive reliving 523 Lev-Wiesel, R. 84, 87
Intrusive thoughts 58, 71 Liberzon, I. 57
Iraq War 19, 54, 144 Lieux de memoire 101, 104, 1067, 173
Islam 88 Life review 94, 141, 155
Islamic enemy 122 Life story 3, 4, 115, 128
Life-threatening 7
James, William 114 Lilienfeld, S. O. 55
Janet, Pierre 17, 20, 63, 68, 74, 118, 139 Lille Gate 192
Janoff-Bulman, R. 62 Bar and museum 194
Jelicic, M. 34 Limbic system 72
Jericho 14 Lind, C. 129
Jesus 82 Linley, A. 81, 94, 116
Jones, E. 20, 22, 23 Lipgar, R. M. 19
Jones, R. 182 Literature 3, 13, 14, 21, 197
Joseph, S. 81, 94, 116, 117, 119 As psychological data 161
Judah, T. 109 Trauma 16171
Judaism 88 Logotherapy 88
Jung, K. 1056 Longest Day, The 1067
Justifiable war 150 Lutyens, Edwin 176
Kahana, B. 140 Macaskill, N. 116

Kaloupek, D. G. 74 Macbeth 154
Kakierska, K. 111 Machine gun 180
Kamierska, K. 122 MacIntyre, A. 115
Kang, H. K. 54 Maercker, A. 87
Keegan, J. 25 Magnetic Resonance Imaging 29, 33
Kenyon, G. M. 159 Functional MRI 33
Kern, D. E. 54 Maguire, E. A. 75
Kihlstrom, J. F. 116, 125 Mahan, C. M. 54
Kilshaw, S. 136 Malazia, A. L. 72
Kirschenbaum, L. 178, 179 Malingering 22
Knapp, A. B. 117 Mao, Chairman 1, 5
Index 227
Marathon, battle of 15 Social 1056

March, J. S. 57 Transition to past 103
Margorinos, M. 72 Memory and History 6, 13, 96, 98
Marino, F. 155 Memory Studies 98
Marr, R. A. 75, 76 Menchu, Rigoberta 118
Marshall, General George 25 Menin Gate 175, 177, 186, 188, 190
Marshall, M. 141 Ceremony 192
Martin, J. R. 120 Menin Road 191
Maslow, A. 82, 87 Mental decline 140
Mason, J. W. 7 Mental defeat 62
Mayes, R. 52 Messines Ridge 188
McAdams, D. P. 129 Meta-analysis 119
McCabe, A. 43 Michaels, C. E. 64
McCauley, J. 54 Miller, N. 27
McEwen, B. S. 72 Mishler, E. G. 43, 120
McFarlane, A. 57, 64, 79 Mizes, J. S. 155
McHale, S. 160 Mnemonic battles 122
McNally, R. J. 62 Mnemonic socialisation 121
Meaning 78, 85, 88, 115, 116, 163 Mnemosyne 98
Making 95 Morale 26
Media 120 Moskovitz, R. 87
Medial prefrontal cortex 72, 76 Motivation 82
Mediating variables, protective 140 Motor cortex 72
Medical model 56, 59 Mulder, R. T. 63
Meichenbaum, D. 92 Murray, J. 63
Memorial 101 Museum
Bosnia 110 Modernisation 189, 194
Memorialisation 13, 17285, 200 Myers, Charles 20, 21, 23
Germany 181 Mythology 175
Japan 181
Psychological benefits 180 Najarian, L. M. 140
Memories, veterans 144 Napoleonic Wars 16
Memory 2, 96, 201 Narcosynthesis 25
Active 64 Narrative 3, 4, 5, 6, 13, 59, 62, 63, 66, 74,
Autobiographical 116 78, 92, 978, 1978, 203
Change 148 Affect 134
Collapse 100 In All Quiet on the Western Front 170
Confabulated 70, 116 Analysis 42, 45
Constructed 109 Change 114
Consummate 145 Coherence 128, 129
Coping with 14855 Measurement 130
Emotional 70, 73 Methodology 129
Explicit 66, 68, 69, 74, 76, 78 Coherent 137
Development 136 Complexity 115
Fabricated 117 Content 129
Fiction 1656 Critique of methods 45
Flexibility 23 Cultural 120
Fragmentation 119 Development 79, 1256
Historical 99 And trauma 126
Implicit 65, 66, 68, 74, 77 Disorganised 90, 137
And narrative 160 Dissociated 90
Personal 99 Dominant 90
Reconstruction 116 Form 129
Recovered 117 Fragmentation 137
Retrospective 145 Gerontology 159
228 Index
Narrative (cont.) Olick, J. K. 98

And growth 95 Oral history 6, 107, 121
Identity 159 Oral History 1089
Individual 173 Oral tradition 100
Integration 134, 1358 Orr, S. P. 67
Interview 30 Orwell, George 1078
Memory 116 Orwellian 122
Methods 435, 57, 202 Owen, Wilfrid 18, 19, 20, 161
Neuroimaging 75 Strange Meeting 162
Neuroscience 35, 75
Orientation 133 Palestine 5
And past 98 Pals, J. L. 116
Structure 133 Paradores 102
System of personal knowledge 116 Paralysis, hysterical 124
Therapy 131 Parietal cortex 72
Turn to 116, 203 Park, C. 85
Narrative Exposure Therapy 32, 117 Passchendaele 104, 175, 186
Narrative growth 8991 Patroclus 14
National Memorial Arboretum Pennebaker, J. 91, 115
1834, 200 Pepys, Samuel 15
Naziism 84, 111 Perception 61
Neimeyer, R. A. 90 Perceived benefits 82
Nemeroff, C. B. 53, 54, 72, 119 Perrott, K. 119
Ness, G. J. 116 PET scan, see Positron Emission
Network formation 64 Tomography
Neuropsychological mechanisms Phobia 58
34, 714 Phrenology 34
Neuroticism 74 Physical illness 74
New Labour 112 Physiological explanation 17
NICE Guidelines 31, 54 Physiological reactivity 53
Nietsche, F. 81 Picasso, Pablo 117
Nightmares 15, 52, 146 PIE (Proximity, Immediacy, Expectancy)
Measuring 39 22, 25, 123
Nineteen Eighty-Four 108 PILOTS database 51
No choice 14950 Pines, M. 19
Non-fiction fiction 118 Pitman, R. K. 72
Nora, P. 98, 1001, 106, 109, Pleasure principle 88
173, 199 Poetry 20, 1523
Noradrenaline 73, 74 Poland 111, 122, 154
Noriega, General 14 Politics 44
Normandy 26 Pol Pot 5
Battlefield 174 Politics, memory and history 10913
Veterans 144, 198 Population
Northern Ireland 110 Bias 47
Nostalgia 16 Representativeness 45, 47
Notestine, C. F. 72 Positive by-products 82
Not Yet Diagnosed Nervous 22 Positive growth 10, 81
Novel 3, 125 Positive readjustment 82
War 105 Positron Emission Tomography (PET) 33,
Novoa, O. P. 76 34, 75
Numbing 64 Posner, M. I. 74
Nutt, D. J. 72 Posterior cingulate 72
Post-traumatic growth 12, 82, 163
Occupation 122 Post-traumatic Growth Inventory
OKearney, R. 119 (PTGI) 84, 85
Index 229
Post-traumatic stress disorder 8, 910, 11, Quinlan, M. 172, 176, 178

12, 15, 17, 22, 27, 33, 35, 5060, Quixote, Don 120
68, 73, 78, 81, 123, 127, 128, 140,
162, 196, 199 Rachman, S. 67
Acute 9, 53 Racists 122
Biological markers 58 Railway Spine 16
Chronic 9, 53, 68 Randall, W. L. 159
Complex 9, 58 Random allocation 31, 32
Core assumptions 55 Randomised Controlled Trials
Criterian A 56 29, 302
Critique 558 Ranger, T. 107
Delayed onset 9, 53 Rape narratives 128
Diagnostic criteria 76 Reach for the Sky 106
Factor structure 57 Reconciliation 128
Hybrid disorder 71 Recovery 66, 117
Law 54, 55 Re-experiencing 52, 161
Measurement of 37 Refugees 32, 59
Narratives 119 Bosnian 70
Neural pathways 72 Refugee camp 31, 32, 38, 47
Ontological status 58 Reid, J. J. 16, 17
Simple 9, 58 Religion 82, 89
Similar symptoms 18 Remarque, Erich Maria 19, 105,
Potter, J. 42 163, 197
POW 93, 144, 150 Remembrance 102, 1078, 172
Of Japanese 1423, 151 Day 135, 172
Powell, S. 85 Reminders 8
Pre-frontal cortex 29, 73 Reminiscence 159
Processing 8, 64, 67, 78, 1524, Repertory grid 91
170, 199 Repression 27, 63
Cognitive 20 Republika Srpska 110
Cycles with avoidance 79 Research methods 12, 2849
Propanolol 73 Retrospective study 33
Protestantism 97 Rexhaj, B. 125
Psychiatric Riessman, C. K. 45
Casualties 18, 21, 25 Rift 58
hospital 18 Riggs, D. S. 68
Psychoanalysis 63 Right to life 78
Psychodynamic approaches 767 Risk assessment 49
Psychological Ritualisation and commemoration 173
Breakdown 18 Rivers, William H. R. 18, 20, 123, 124
Perceived permanence of Road Back, The (Remarque) 164
breakdown 26 Robbins, I. 40, 54, 65, 79, 127, 140, 141,
Problems in battle 18 142, 162, 168
Psychometric 35, 39 Robin Hood 107
Pynoos, R. S. 140 Rogers, C. 87
Rothbaum, B. O. 68, 119
Quasi-experiments 33, 34 Rosen, E. 55, 57
Questionnaires, self-report 29, 3540, Rosenheck, A. 86, 140
84, 142 Rosner, R. 85
Combat experience 142 Ross, D. 116
Interpretation of 39 Rowlings, C. 141
Other languages 36 Royal Air Force 26, 142
Problems with 94, 95 Royal Marines 142
Scoring 39 Royal Navy 142
World War Two veterans 1423 Rumination 147, 152
230 Index
Russian enemy 122 Veterans associations 157

Russo-Japanese War 18 Wives 156
Sodium amytal 24, 25
Sallyport memorial 183 Soldiers 59
Salmon, T. W. 20 As family 11
Sanctuary Wood 190, 1912 Leaving armed forces 11
Sargant, W. 24, 26, 27, 123 Shot 18
Sartre, Jean Paul 82 Soldiers heart 17, 71
Sassoon, Siegfried 18, 20, 105 Something to live for 151
Schauer, M. 117 Somme 104, 110, 172
Schemata 64, 69 Battlefield 174
Schreiber, N. 121 Southwick 73
Science 28, 30 Soviet Union 1078
Sebald, W. 112 Speed 64
Sedation 25 Spirituality 889
Sel, R. 63 Spiro, A. 140
Self 115 Squire, C. 115
Self-concept 116 Srebrenica 110
Self-exposure (researcher) 478 Stalin, Josef 1, 5, 1078
Selye, H. 7 Stamm, R. 72, 73, 75
Serbian nationalism 110 Stamp, G. 175
Serbs 109 Stein, N. 130
Shakespeare 15, 82, 120 Stewart, B. S. 111
Shalev, A. 64 Stiff upper lip 26, 159
Shame 62 Stone, Oliver 117, 161
Shay, J. 13, 15, 162, 170 Story 44, 117, 162
Shellshock 11, 20, 21, 22, 23, 71, 123, 161 Characteristics 130
War Office Committee on 23 Comprehension 75
Shirlow, P. 110 Storytelling 3, 44, 92, 115
Siddharthe Gautama 82 Stoyle, M. 111
Sierra Leone Civil War 38 Strauss, A. 41, 164
Sigal, J. J. 87 Strecker, E. A. 23
Silver, R. C. 63 Stress 6
Silverman, D. 45 Stress response 7
Simms, L. J. 57 Stress and trauma 7
Singer, J. A. 125 Stressor criterion 89, 52, 56
Situationally accessible memory Stress-related growth 82
(SAM) 68, 70 Stress-Related Growth Scale 85
Slater, E. 27 Stroop test
Sloggett, Sir Arthur 22 Students 38
Smith, T. S. 69 Substance abuse 12, 57
Smith, J. 42 Suffering 82, 163
Smokers, social outcasts 122 Supervisor 48
Social construction 5, 45 Surtees, William 16
Social continuity 1056 Survival mechanism 73
Social discourse 4, 5, 13, 97, 1204 Survivor guilt 16
Social identity 1056 Systematic review 32
Sociology 13
Social discourse 114, 198 Tajfel, H. 122
and individual narrative 159 Tavistock 111
Social Support 3, 8, 79, 90, 12739, Tedeschi, R. G. 84, 87, 88, 163
1557, 199 Terr, L. 68
Comrades 1567 Terrorism, Islamic 122
Emotional attachment 158 Terrorist threat 54
Perceived 54 Text 45
Index 231
Thalamus 72, 73 Validation, questionnaires 36

Thankful villages 172 Van der Hart, O. 68
Thatcher, M. 182 Van der Kolk, B. 66, 68, 69, 139, 162,
Thelen, D. 1078, 173 170, 186
Theory Van der Ploeg, H. M. 140
Integrating 50, 79 Vauban 187
Therapy 2, 46 Verbally accessible memory
Thiepval 110, 175, 177 (VAM) 68, 70
Thriving 82 Verbal memories 34
Tolstoy, Leo 17 Vermetten, E. 72
Toulon 18 Versailles, Treaty of 176
Tragedy 163 Veterans 79, 113, 128, 129, 138, 200
Training 168 Treatment 141
Trandel 62 Falklands 135
Transcranial Magnetic Stimulation Iraq 134
(TMS) 33 Vietnam 15, 51, 62, 63, 72, 78
Trauma World War One 22
And aging 13 World War Two 40, 44
Narrative 44 Vicarious trauma
Reliving 26 Vietnam War 27, 51, 123
Traumatic exposure 52 Films 117, 161
Traumatic event 68 Voluntary participation 46, 47
Traumatic memory 7, 15, 58, 63, 74, 78,
119, 128 Waco, siege of 14
Theories 61 War
Traumatic neurosis 51, 76, 123 Normal lives 60
Traumatic stress 2, 116 War crimes 109
Traumatic stressor 9, 52, 76 War criminal, Tony Blair 19
Treatment 2, 54, 201 War graves 172
World War Two veterans 141 War memorial 1056, 172
Triangulation of research 29 War neurosis 11, 23, 25
Trimble, M. 14 War trauma 6, 8, 10, 12, 21, 27, 50, 51, 58,
Troy, siege of 14 78, 114, 203
Truth and Reconciliation Complexity 38, 60
Committee 109 Ethics 45
Tsunami 37 Interview 42
Turner, R. J. 155 Meaning of problem 423
Two-minute silence 173 Narrative 117
Tyne Cot 175, 177, 189, 193 Reconciled 135
War zones 28, 46, 47
Ulysses 120 Visiting 48
Unconscious 77 Watson, P. 168
Universality and cultural Waugh, M. 144
specificity 199 Weine, S. M. 66, 70
Unknown soldier 188 Wellbeing
Unknown Warrior 1778 Storyteller 138
Ursin, H. 7 West, Rebecca 105
USA Western Front 164
Empire 125 Weston, Simon 116
Holocaust 5 Wetherall, M. 42
Psychiatric casualties 123 Wilkomirski, B. 118
Williams, L. M. 72
Validity Wilson, B. A. 75, 187
Construct 37 Wilson, R. A. 98, 114, 172
Face 38 Wilson, J. P. 27, 77
232 Index
Wingfield Manor 102 Memories 121

Wisdom 163 Memory and coping 14260
Witchcraft 14 Narratives 122
Witnesses 121 Psychological trauma 123
Wolfe, J. 74 Researcher knowledge 44
Women 54, 144 Treatment 27
And war 161 US veterans 86
Working memory 75, 76 Veterans 66, 75, 84, 93, 104, 121, 132,
World War One 11, 15, 18, 19, 22, 71, 136, 137, 140, 141, 142, 159
1034, 123, 180 Written accounts 43
Commemoration and memorialisation Wyre, H. K. 115
112, 175
Poetry 20, 161 Yalom, I. 88
Psychiatric services 19, 22 Yealland, L. 21
Psychological cause 21 Yehuda, R. 34, 57, 140
Shellshock 20 Ypres 1869
Shot for cowardice 123 Cloth Hall 190
Treatment 22 Museum 194
Veterans, traumatised 124
War graves 172 Zerubavel, E. 121, 122
World War Two 11, 18, 23, 24, 27, 51, 97, Zoellner, L. A. 128
1056, 109 Zonnebeke 1934
Atrocities 110
Bombing Germany 112 36th Ulster Division 110
Interviewing 14457

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How does the book argue that understanding war trauma requires understanding both individual and societal perspectives?

How does the book argue that understanding war trauma requires understanding both individual and societal perspectives?

What are some of the methods and approaches discussed for understanding trauma?

What are some of the methods and approaches discussed for understanding trauma?

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Memory, War and Trauma

Many millions of people are affected by the trauma of war. Psychologists

n i g e l c . h u n t is Associate Professor in the Institute of Work,

Cambridge University Press

This publication is in copyright. Subject to statutory exception and to the

ISBN-13 978-0-511-72974-4 eBook (NetLibrary)

ISBN-13 978-0-521-71625-3 Paperback

1 Background and purpose 1

I am also grateful to the University of Helsinki, particularly Airi

I was recently asked to write about the health consequences of war

Narrative, social discourse and collective memory

Collective memory is important for the notion of commemoration and

are traumatised. They find it difficult to cope with ordinary living,

of fear, helplessness or horror, then it was considered satisfactory for

Post-traumatic stress disorder

The main symptoms are, in themselves, often normal responses when

Trauma and identity

of other names have been applied to essentially the same condition:

After the war: soldiers leaving the armed forces

emerge having experienced positive life changes, for example a better

The effects of traumatic war experience have been recorded throughout

would now describe as PTSD: bad dreams, withdrawal, social isolation,

This piece illustrates that the fundamental symptoms of traumatic stress

Perhaps we will leave it to Shakespeare.

range of symptoms: intrusive images, feelings of detachment, memory

a weakness on the part of an individual rather than as a sensible reaction

Why speak not they of comrades that went under?

Charles Myers ended up serving in France through most of the war.

Drug treatments had become available to treat war trauma;

Randomised controlled trials

Any findings may be limited in scope because of the compromise, but

Other experimental techniques

in their training, but who can be predicted to be exposed to traumatic

If a questionnaire is going to be useful, it must be based on sound

Problems with self-report measures

There are too many measures

commercially available, and be very expensive, or the researcher may

Measures are not always based on good theory, or they

Associated with the previous point is that a self-report

Measures may lack face validity, or be ambiguous to the user

The items do not have theoretical equivalence but

Each persons interpretation of what is meant by

A related issue is how a participant scores a questionnaire

Specific items within the questionnaire may be interpreted

Questionnaires are useful for group data but of little

Clinical assessment and case studies

interpretative phenomenological analysis (Smith et al., 2009), various

The difficulty with narrative methods lies in the complexity of the

will be discussed in more detail in Chapter 10. The social constructions

Causing distress to the traumatised participant

as vicarious traumatisation, and relates to both the effects on resear-

Visiting war zones or dangerous places

Ethical issues a conclusion

introduced, there has been a plethora of papers and books published.