Wounded in action
Haunted by his experiences as
an army medic in Iraq, David McGough couldn't cope
with life after his tour of duty. Yet it took two
failed suicide attempts before he was diagnosed as
suffering from post-traumatic stress disorder. Alison
Roberts on the forgotten casualties of the war
02/04/05 "The
Guardian" -- The first symptom was
sleeplessness. It was July 2003 and Lance Corporal
David McGough of the Royal Army Medical Corps was just
back from a five-month tour of duty in Basra, Iraq.
Lots of the lads from his unit had trouble settling
back to a normal routine at first, but most were OK
within a fortnight or so. David, however, did not
sleep for an entire month.
"My body just wouldn't switch off," he tells me,
fidgeting with his hands. "All the time this tension
was building, this incredibly tense restlessness. I
was going for weeks without any sleep at all and then
collapsing, sleeping for maybe six hours, and then
starting all over again." At night, on leave, he
walked around his small maisonette in a suburb of
Preston, Lancashire, folding and re-folding his
clothes, checking and double-checking the locks,
looking over his shoulder repeatedly for imagined
intruders.
McGough was vomiting every day, often bloodily. The
odour of cooking or burned meat made him sick, though
"the worst thing is the smell of public toilets".
"That brings the PoW camps back. The stench of those
places was horrendous."
Mostly it was the insomnia that started to drive him
mad, that made him crash his car and almost beat his
then-fiancee, that both masked and exacerbated his
chronic underlying depression. The army doctor at the
camp in Preston prescribed him Prozac and more or less
told him to pull himself together. When Prozac failed
to work, McGough was given a stronger antidepressant,
citalopram, "but no sleeping tablets, and by then -
Christmas - I wasn't really sleeping at all".
McGough's two attempts at suicide, both at Christmas
in 2003, were more cries for help than committed bids
to kill himself. On the first occasion he held a knife
across his throat until his sister begged him to put
it down, and on the second he put a 9mm pistol to his
head but did not pull the trigger fully. Horrified by
what was happening, McGough's father, a civil servant
based in Northern Ireland, called Dr Alun Jones, a
civilian psychiatrist who specialises in diagnosing
and treating psychological problems in servicemen and
women. "It was immediately clear," says Jones, "that
McGough was suffering a severe case of post-traumatic
stress disorder."
So far, PTSD experts have seen a mere handful of
British sufferers from this latest war in Iraq - but
as the violence goes on, the trickle is expected to
become a flood. Late last year, the independent
inquiry into Gulf war illnesses chaired by Lord Lloyd
of Berwick came to the conclusion that there was
"every reason" to accept the existence of a Gulf war
syndrome, and that post-traumatic stress was one of
several contributing factors. Though the Ministry of
Defence does not publish statistical predictions,
military psychiatrists in America have been warned to
expect psychiatric disorder to occur in a remarkable
20% of servicemen and women returning from Iraq.
"What we've got now is a situation starting to
approximate to Northern Ireland or Bosnia, to civil
insurrection rather than a straight shooting war,"
says Jones, who runs PTSD clinics around the country
and at a residential centre in north Wales."In those
kinds of circumstances, where you're experiencing
hatred and violence from an unpredictable civilian
population, we tend to get a lot of very disturbed and
damaged soldiers." In the field of trauma studies,
this atmosphere of constant and random danger is known
by the shorthand "no safe place".
Other surveys suggest that roughly half the servicemen
who suffer psychiatric illness as a result of
traumatic events do not seek medical help, or do so
years later, when the psychological afterburn has
irreparably damaged marriages, careers and mental
wellbeing. "And there's still a stigma attached," says
Leigh Skelton, director of clinical services at Combat
Stress, the ex-services mental welfare charity. "PTSD
is seen as a career-stopper within the army.
Generally, the first line of action servicemen and
women take is to bottle it up. Then they'll
self-medicate, usually with alcohol, sometimes with
other substances. Cries for help often come from
relatives rather than from the affected person."
Symptoms range from insomnia, nausea and extreme
fatigue to the classic "flashback"; aggression,
feelings of alienation and irrational anger. Sometimes
the disorder centres on one particular memory. A
30-year-old female ambulance driver in the Territorial
Army, for example, constantly replays the moment her
vehicle was blown up last year by a hand-made bomb
tied to a lamp-post in Basra. One marine in his early
20s now suffering chronic PTSD remembers "the fear in
the eyes of an Iraqi soldier in the window" of a
building mortared by the British; and seeing that fear
again when British soldiers mistakenly opened fire on
a civilian vehicle.
McGough, however, identified no single trigger. Skinny
and pale, when I met him in late November he was a
shadow of the strong young man he was pre-Iraq - the
high-flyer who studied psychology at Queen's College,
Belfast, who loved to sky-dive and socialise, who was
promoted within a year of joining the RAMC. For him,
the pressure began the moment he and his medical unit
moved into Iraq, at 2.30am on the first night of the
war, four hours after the Americans began their aerial
bombardment of Baghdad.
McGough was 21 years old and effectively in charge of
80 rookie soldiers fresh out of training, most of them
still teenagers. As medics, they travelled in
canvas-roofed trucks and were not equipped with body
armour. "There was gunfire everywhere. Some of them
were literally crapping themselves in the back of
those trucks." That first night, there wasn't even
time to pitch camp. "The worst casualty I saw was an
Iraqi guy hit about 13 times, big chunks of his
stomach, face and legs just gone. We intubated him and
opened him up by the side of a truck. You do it on
autopilot at the time because your training kicks in.
It's only afterwards you start to think about what
you've seen and done."
The mobile field unit, the first line of medical
services, was initially established just south of
Basra, but was twice relocated to escape attack. Its
job was to mop up trauma cases, stabilise them and
send them to field hospitals nearer the southern
border. According to McGough, the medical unit
received up to 1,000 wounded Iraqis during his
five-and-a-half-month tour of duty, of whom perhaps
60% died and were buried in mass graves.
A large proportion of the medics' work, however, took
place in the PoW camps set up on each site. "Usually
we had about 150 prisoners coming in a day," says
McGough, "both soldiers and civilians who'd been
picked up with guns. Some had clearly been tortured by
the Iraqi regime. There was one man who had thick
black stuff, like goo, coming out of his penis, and
said he'd been injected with something when he was a
prisoner before. Others had quite infected lash wounds
on their backs, or broken jaw bones." The unit also
saw a number of raped women, who were treated and
counselled by a female army gynaecologist.
Seemingly futile or absurd situations are known to
compound wartime trauma. The unit's first location at
Basra was regularly attacked by Iraqis defending a
nearby ammunition dump from a maze-like system of
trenches. "There was no adherence to any kind of
convention on their part. Sometimes it was ridiculous.
Every time we hit and wounded someone, a white flag
would go up on their side and the others would bring
the man we'd wounded over to the base for treatment.
Then they'd go back up and start shooting at us
again."
Most harrowing of all was the discovery of the corpse
of a 12-year-old girl who'd been hanged in a
backstreet alley in Basra. McGough was sent to confirm
the death and recognised her as the child to whom he
and his comrades had chatted the week before. "We
heard later that she was probably hanged by the crowd
because she'd been talking to our crew ... That was
one of the worst things. You expect to see some nasty
stuff, but seeing a little girl hanging in the street
because she once spoke to you ... "
PTSD has been a recognised injury of war for more than
30 years, yet treatment in Britain is still very
patchy. It took complete break-down ("my girlfriend
found me one night huddled on the floor, shaking and
crying") and several emergency trips to hospital in
Preston before McGough was finally prescribed sleeping
tablets. While a member of the British army, he was
unable to access the civilian care system - and had
been informed of a decision to discharge him without a
pension.
"The army is not a branch of the social services,"
says Jones, "but I do think there is a certain duty of
care, knowing what we now know about the effects of
trauma. It would be reasonable to expect the army to
check these lads over for psychological injury when
they come back from combat, but in fact there is no
obligation whatsoever to do this."
"No one rings or visits in the mornings because I'm
just a horrible, nasty person before the drugs have
kicked in," says McGough. He was increasingly
convinced that his physical symptoms - the vomiting
and chronic weight loss - are related to anthrax
injections and to the Naps tablets taken to counter
the potential use of enemy nerve agents. On bad days
he does not get out of bed at all.
"I loved being in the army," he says. "It was supposed
to be my long-term career, and I was prepared to give
everything to it ... I just wish I could shake this
and get on with my life again."
Copyright: The Guardian