Directory

Edgar Jones | King's College London - Academia.edu

Skip to main content

Edgar Jones

King's College London, Institute of psychiatry, psychology and neuroscience, Faculty Member

Followers

89

Following

10

Co-authors

9

Public Views

Paloma Torres-Davila

Universidad de Puerto Rico Rio

Gina Tryapriliyanti

BINUS University

University of Alabama in Huntsville

Andrew J. Smith

University of Utah

Christos Pezirkianidis

Panteion University of Social and Political Sciences

Patti Kelly Harrison

Virginia Tech

Universitetet i Sørøst-Norge / University of South-Eastern Norway

Aultima Ezichi Peters

Chukwuemeka Odumegwu Ojukwu University, Igbariam Campus

University of East London

Gwen Robbins Schug

University of North Carolina at Greensboro

Interests

Uploads

Papers by Edgar Jones

Neuro Psychiatry 1943: The Role of Documentary Film in the Dissemination of Medical Knowledge and Promotion of the U.K. Psychiatric Profession

Journal of the History of Medicine and Allied Sciences, 2012

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

Mental health, ethnicity and the UK armed forces: Historical lessons for research and policy

Asian Journal of Psychiatry, 2024

Background: UK armed forces have recruited from other races and ethnicities at times of crisis. T... more Background: UK armed forces have recruited from other races and ethnicities at times of crisis. To meet diversity targets, they have also recruited indigenous groups of non-White British heritage. Considered at greater risk of mental health problems generally, these populations are likely to suffer more in combat and in transition to civilian life. Yet, there is little data on how they fare. Methods: A scoping review was conducted of peer-reviewed studies of psychological illnesses suffered by racial and ethnic minority soldiers from World War One to the present, together with research at the National Archives, Wellcome Trust Archives and the Imperial War Museum for unpublished studies. Results: British commanders and psychiatrists argued that 'martial races' were protected against post-traumatic illnesses because of an innate resilience related to a rural heritage. Consequently, low morale and breakdown were interpreted as malingering to avoid combat. Indian troops received lower levels of psychiatric care than provided for British soldiers delivered with limited cultural understanding. Inferior terms and conditions were offered to Indian soldiers with lesser opportunities for promotion. These practices, established in both World Wars, continued for Gurkha and Commonwealth soldiers recruited to meet manpower and diversity targets. Disproportionate complaints of discrimination may explain why ethnic minority status is a risk factor for mental illness. Conclusion: Management patterns laid down during the Imperial era continue to influence current practice for ethnic minority service personnel. Yet, armed forces can play a positive role in fostering diversity and integration to provide protective factors against mental illness.

Psychiatric case notes: symptoms of mental illness and their attribution at the Maudsley Hospital, 1924-35

History of Psychiatry, 2012

Case notes of patients treated at the Maudsley Hospital during the interwar period provided data ... more Case notes of patients treated at the Maudsley Hospital during the interwar period provided data about diagnosis, symptoms and beliefs about mental illness. In the absence of effective treatments, patients were investigated in detail in the hope that connections between disease processes might be revealed. We analysed a randomly-selected sample of 700 patients taken equally from 1924, 1928, 1931 and 1935. Eight groups (three representing psychosis and five indicating psychological disorders) were identified on the basis of symptom clusters. Formal diagnosis did not correlate with clusters. Although there was a measure of agreement between patients and doctors about the cause of mental illness, stigma may have inhibited discussion of some themes. Psychiatric diagnosis was informed by symptoms but not determined by them. In an era before classification systems were tested for reliability, diagnosis was fluid, reflecting changing hypotheses about causation, pathology and treatment. Att...

Mental health, ethnicity and the UK armed forces: Historical lessons for research and policy

by Edgar Jones and Laura Palmer

Asian Journal of Psychiatry, 2024

Background: UK armed forces have recruited from other races and ethnicities at times of crisis. T... more Background: UK armed forces have recruited from other races and ethnicities at times of crisis. To meet diversity targets, they have also recruited indigenous groups of non-White British heritage. Considered at greater risk of mental health problems generally, these populations are likely to suffer more in combat and in transition to civilian life. Yet, there is little data on how they fare. Methods: A scoping review was conducted of peer-reviewed studies of psychological illnesses suffered by racial and ethnic minority soldiers from World War One to the present, together with research at the National Archives, Wellcome Trust Archives and the Imperial War Museum for unpublished studies. Results: British commanders and psychiatrists argued that 'martial races' were protected against post-traumatic illnesses because of an innate resilience related to a rural heritage. Consequently, low morale and breakdown were interpreted as malingering to avoid combat. Indian troops received lower levels of psychiatric care than provided for British soldiers delivered with limited cultural understanding. Inferior terms and conditions were offered to Indian soldiers with lesser opportunities for promotion. These practices, established in both World Wars, continued for Gurkha and Commonwealth soldiers recruited to meet manpower and diversity targets. Disproportionate complaints of discrimination may explain why ethnic minority status is a risk factor for mental illness. Conclusion: Management patterns laid down during the Imperial era continue to influence current practice for ethnic minority service personnel. Yet, armed forces can play a positive role in fostering diversity and integration to provide protective factors against mental illness.

They Called it Shell Shock: Combat Stress in the First World War By Stefanie Linden. Helion and Company Limited. 2016. £19.99 (hb). 272 pp. ISBN 9781911096351

The British Journal of Psychiatry, 2018

Moral injury in time of war

Lancet (London, England), May 5, 2018

Railway Suicides in the UK, risk factors and prevention strategies

Citing this paper Please note that where the full-text provided on King's Research Portal is ... more Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.

Extremism and common mental illness: cross-sectional community survey of White British and Pakistani men and women living in England

The British Journal of Psychiatry, 2019

BackgroundMental illnesses may explain vulnerability to develop extremist beliefs that can lead t... more BackgroundMental illnesses may explain vulnerability to develop extremist beliefs that can lead to violent protest and terrorism. Yet there is little evidence.AimsTo investigate the relationship between mental illnesses and extremist beliefs.MethodPopulation survey of 618 White British and Pakistani people in England. Extremism was assessed by an established measure of sympathies for violent protest and terrorism (SVPT). Respondents with any positive scores (showing sympathies) were compared with those with all negative scores. We calculated associations between extremist sympathies and ICD-10 diagnoses of depression and dysthymia, and symptoms of anxiety, personality difficulties, autism and post-traumatic stress. Also considered were demographics, life events, social assets, political engagement and criminal convictions.ResultsSVPT were more common in those with major depression with dysthymia (risk ratio 4.07, 95% CI 1.37–12.05, P = 0.01), symptoms of anxiety (risk ratio 1.09, 95...

Pathways to sympathies for violent protest and terrorism

The British journal of psychiatry : the journal of mental science, Dec 8, 2016

Radicalisation is proposed to explain why some individuals begin to support and take part in viol... more Radicalisation is proposed to explain why some individuals begin to support and take part in violent extremism. However, there is little empirical population research to inform prevention, and insufficient attention to the role of psychiatric vulnerabilities. To test the impact of depressive symptoms, adverse life events and political engagement on sympathies for violent protest and terrorism (SVPT). A cross-sectional survey of a representative sample of Pakistani and Bangladeshi men and women from two English cities. Weighted, multivariable, logistic regression yielded population estimates of association (odds ratio (OR) and 95% confidence intervals) against a binary outcome of SVPT derived from a three-group solution following cluster analysis. Depressive symptoms were associated with a higher risk of SVPT (OR = 2.59, 95% CI 1.59-4.23, P < 0.001), but mediated little of the overall effects of life events and political engagement, which were associated with a lower risk of SVPT ...

The role of doctors in investigation, prevention and treatment of torture

Journal of the Royal Society of Medicine, 2012

Summary Doctors may assess and treat torture survivors; some may document crucial evidence of tor... more Summary Doctors may assess and treat torture survivors; some may document crucial evidence of torture in medico-legal reports. However, there is a lack of education on torture and related ethical and legal issues at undergraduate and postgraduate level and many doctors are not aware of opportunities to work with organisations for the prevention of torture. This paper defines Torture, describes methods used, and sets out the human rights instruments and codes of ethical practice that mandate efforts to prevent torture. Medical complicity in torture is discussed and the need for national and international medical associations to prevent torture by both supporting doctors and recognising and tackling medial complicity. The paper offers guidance for assessing and documenting torture, and for providing health care for survivors of torture.

Trans-Generational Transmission of Traumatic Memory and Moral Injury

Military Behavioral Health, 2018

If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.

Battle for the mind: World War 1 and the birth of military psychiatry

Lancet, Jan 8, 2014

The 100th anniversary of the outbreak of World War 1 could be viewed as a tempting opportunity to... more The 100th anniversary of the outbreak of World War 1 could be viewed as a tempting opportunity to acknowledge the origins of military psychiatry and the start of a journey from psychological ignorance to enlightenment. However, the psychiatric legacy of the war is ambiguous. During World War 1, a new disorder (shellshock) and a new treatment (forward psychiatry) were introduced, but the former should not be thought of as the first recognition of what is now called post-traumatic stress disorder and the latter did not offer the solution to the management of psychiatric casualties, as was subsequently claimed. For this Series paper, we researched contemporary publications, classified military reports, and casualty returns to reassess the conventional narrative about the effect of shellshock on psychiatric practice. We conclude that the expression of distress by soldiers was culturally mediated and that patients with postcombat syndromes presented with symptom clusters and causal inter...

The Origins of British Military Psychiatry Before the First World War

War & Society, 2001

Military psychiatry in the United Kingdom is generally regarded as having begun in the First Worl... more Military psychiatry in the United Kingdom is generally regarded as having begun in the First World War'! Certainly, it then became an important service designed in the main to treat troops suffering from shell shock and battle exhaustion so that they could be returned to their units as quickly as possible. However, a significant developmental phase pre-dated this conflict when physicians were presented with servicemen suffering from a range of unexplained, somatic disorders, including Disordered Action of the Heart (DAH) and psychogenic rheumatism. These arose in a context of 'palpitation' seen during the Crimean War and irritable heart described by Da Costa in the American Civil War. In addition, military doctors encountered cases whose symptomatology suggested a neurological cause. These were both acute (cases of exhaustion after combat) and chronic (servicemen who remained debilitated for years after their discharge). Although the discipline of psychiatry remained embryonic in the UK divided between alienists, who treated so-called lunatics in asylums,2 and physicians with an interest in psychological matters, there was a small but growing debate about medically unexplained disorders. Neurasthenia and the phenomenon of railway spine tended to divide doctors into those who sought an organic explanation and those who interpreted these as psychological disorders. Furthermore, the rapidly filling asylums encouraged ideas of degeneracy in which the masses were wrecking civilisation with their mental imbecility or savagery, pre-Dr Edgar Jones was supported by a grant from the US Departnlent of Defense. Unless stated otherwise, all archival references are from the Public Record Office, Kew. 2.

Hearts, guts and minds

Journal of Psychosomatic Research, 2004

Objectives: To identify patterns of somatisation in army personnel diagnosed with postcombat synd... more Objectives: To identify patterns of somatisation in army personnel diagnosed with postcombat syndromes from the Boer War to the Gulf conflict. Methods: Using random samples of UK servicemen awarded war pensions, patterns of symptoms were compared and related to contemporary accounts. Results: Somatic symptoms continued to be common during and after World War II, suggesting that their decline was not great as claimed. Although psychological presentations increased, they did not supplant conversion disorders. Conclusion: Somatoform disorders did not disappear from the military in a smooth progression as society's understanding of psychological issues advanced. Rather there was a change in physical focus from the heart to the gut as new medical priorities arose.

A paradigm shift in the conceptualization of psychological trauma in the 20th century

Journal of Anxiety Disorders, 2007

The inclusion of posttraumatic stress disorder (PTSD) in DSM-III in 1980 represented a paradigm s... more The inclusion of posttraumatic stress disorder (PTSD) in DSM-III in 1980 represented a paradigm shift in the conceptualisation of post-trauma illness. Hitherto, a normal psychological reaction to a terrifying event was considered short-term and reversible. Long-term effects, characterized as ''traumatic neurosis'', were regarded as abnormal. Enduring symptoms were explained in terms of hereditary predisposition, early maladaptive experiences or a pre-existing psychiatric disorder. The event served merely as a trigger to something that existed or was waiting to emerge. Secondary gain, the benefits often but not solely financial that a person derived as a result of being ill, was considered the principal cause of any observed failure to recover. The recognition of PTSD reflected a diversion from the role of the group, in particular the ''herd instinct'', towards a greater appreciation of the individual's experience. From being the responsibility of the subject, traumatic illness became an external imposition and possibly a universal response to a terrifying and unexpected event. This shift from predisposition to the characteristics of the event itself reduced guilt and blame, while the undermining of secondary gain made it easier to award financial compensation.

‘The gut war’

History of the Human Sciences, 2012

Hospital admission and mortality statistics suggested that peptic ulcer reached a peak prevalence... more Hospital admission and mortality statistics suggested that peptic ulcer reached a peak prevalence in the mid-1950s. During the Second World War, against this background of serious and common pathology, an epidemic of dyspepsia afflicted both service personnel and civilians alike. In the absence of reliable diagnostic techniques, physicians struggled to distinguish between life-threatening illness and mild, temporary disorders. This article explores the context in which non-ulcer stomach conditions flourished. At a time when fear was considered defeatist and overt psychological disorder attracted stigma, both soldiers and civilians exposed to frightening events may have unconsciously translated their distress into gastrointestinal disorders. While the nature of army food was initially identified as the cause of duodenal ulcer in servicemen, the pre-war idea that conscientious and anxious individuals were at high risk gathered support and fed into post-war beliefs that this was a stre...

Civilian Morale During the Second World War: Responses to Air Raids Re-examined

Social History of Medicine, 2004

EDGAR JONES a , ROBIN WOOLVEN b , BILL DURODIÉ c , and SIMON WESSELY d SUMMARY. The impact of air... more EDGAR JONES a , ROBIN WOOLVEN b , BILL DURODIÉ c , and SIMON WESSELY d SUMMARY. The impact of air raids on civilian morale during the Second World War has been the subject of much dispute. Official histories concluded that the mental health of the nation may have improved, while panic was a rare phenomenon. Revisionist historians argued that psychiatric casualties were significantly higher than these accounts suggested because cases went unreported, while others were treated as organic disorders. Using contemporary assessments and medical literature, we sought to re-evaluate the psychological effect of bombing. There is little evidence to suggest that admissions for formal mental illness increased appreciably, although a question remains about the incidence of functional somatic disorders, such as non-ulcer dyspepsia and effort syndrome. The fact that civilians had little to gain from hospitalization in part explained why dire predictions of mass air-raid neurosis failed to materialize. In the event, civilians proved more resilient than planners had predicted, largely because they had underestimated their adaptability and resourcefulness, and because the lengthy conflict had involved so many in constructive participant roles.

The return of the traumatized army veteran: a qualitative study of UK ex-servicemen in the aftermath of war, 1945 to 2000

International Review of Psychiatry, 2019

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

The symptomatology of psychological trauma in the aftermath of war (1945-1980): UK army veterans, civilians and emergency responders

Psychological medicine, Jan 21, 2018

UK veterans suffering from a psychological or psychiatric illness as a consequence of service in ... more UK veterans suffering from a psychological or psychiatric illness as a consequence of service in the Second World War were entitled to a war pension. Their case files, which include regular medical assessments, are a valuable resource to investigate the nature, distribution and duration of symptoms. A standardised form was used to collect data from pension records of a random sample of 500 UK army veterans from the first presentation in the 1940s until 1980. Data were also gathered from 50 civilians and 54 emergency responders with a pension for post-traumatic illness following air-raids. The 10 most common symptoms reported by veterans were anxiety, depression, sleep problems, headache, irritability/anger, tremor/shaking, difficulty completing tasks, poor concentration, repeated fears and avoidance of social contact. Nine of the 10 were widely distributed across the veteran population when symptoms were ranked by the number of subjects who reported them. Nine symptoms persisted sig...

War Syndromes from 1900 to the Present: Symptom Patterns and Longterm Health Outcomes

Neuro Psychiatry 1943: The Role of Documentary Film in the Dissemination of Medical Knowledge and Promotion of the U.K. Psychiatric Profession

Journal of the History of Medicine and Allied Sciences, 2012

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

Mental health, ethnicity and the UK armed forces: Historical lessons for research and policy

Asian Journal of Psychiatry, 2024

Background: UK armed forces have recruited from other races and ethnicities at times of crisis. T... more Background: UK armed forces have recruited from other races and ethnicities at times of crisis. To meet diversity targets, they have also recruited indigenous groups of non-White British heritage. Considered at greater risk of mental health problems generally, these populations are likely to suffer more in combat and in transition to civilian life. Yet, there is little data on how they fare. Methods: A scoping review was conducted of peer-reviewed studies of psychological illnesses suffered by racial and ethnic minority soldiers from World War One to the present, together with research at the National Archives, Wellcome Trust Archives and the Imperial War Museum for unpublished studies. Results: British commanders and psychiatrists argued that 'martial races' were protected against post-traumatic illnesses because of an innate resilience related to a rural heritage. Consequently, low morale and breakdown were interpreted as malingering to avoid combat. Indian troops received lower levels of psychiatric care than provided for British soldiers delivered with limited cultural understanding. Inferior terms and conditions were offered to Indian soldiers with lesser opportunities for promotion. These practices, established in both World Wars, continued for Gurkha and Commonwealth soldiers recruited to meet manpower and diversity targets. Disproportionate complaints of discrimination may explain why ethnic minority status is a risk factor for mental illness. Conclusion: Management patterns laid down during the Imperial era continue to influence current practice for ethnic minority service personnel. Yet, armed forces can play a positive role in fostering diversity and integration to provide protective factors against mental illness.

Psychiatric case notes: symptoms of mental illness and their attribution at the Maudsley Hospital, 1924-35

History of Psychiatry, 2012

Case notes of patients treated at the Maudsley Hospital during the interwar period provided data ... more Case notes of patients treated at the Maudsley Hospital during the interwar period provided data about diagnosis, symptoms and beliefs about mental illness. In the absence of effective treatments, patients were investigated in detail in the hope that connections between disease processes might be revealed. We analysed a randomly-selected sample of 700 patients taken equally from 1924, 1928, 1931 and 1935. Eight groups (three representing psychosis and five indicating psychological disorders) were identified on the basis of symptom clusters. Formal diagnosis did not correlate with clusters. Although there was a measure of agreement between patients and doctors about the cause of mental illness, stigma may have inhibited discussion of some themes. Psychiatric diagnosis was informed by symptoms but not determined by them. In an era before classification systems were tested for reliability, diagnosis was fluid, reflecting changing hypotheses about causation, pathology and treatment. Att...

Mental health, ethnicity and the UK armed forces: Historical lessons for research and policy

by Edgar Jones and Laura Palmer

Asian Journal of Psychiatry, 2024

Background: UK armed forces have recruited from other races and ethnicities at times of crisis. T... more Background: UK armed forces have recruited from other races and ethnicities at times of crisis. To meet diversity targets, they have also recruited indigenous groups of non-White British heritage. Considered at greater risk of mental health problems generally, these populations are likely to suffer more in combat and in transition to civilian life. Yet, there is little data on how they fare. Methods: A scoping review was conducted of peer-reviewed studies of psychological illnesses suffered by racial and ethnic minority soldiers from World War One to the present, together with research at the National Archives, Wellcome Trust Archives and the Imperial War Museum for unpublished studies. Results: British commanders and psychiatrists argued that 'martial races' were protected against post-traumatic illnesses because of an innate resilience related to a rural heritage. Consequently, low morale and breakdown were interpreted as malingering to avoid combat. Indian troops received lower levels of psychiatric care than provided for British soldiers delivered with limited cultural understanding. Inferior terms and conditions were offered to Indian soldiers with lesser opportunities for promotion. These practices, established in both World Wars, continued for Gurkha and Commonwealth soldiers recruited to meet manpower and diversity targets. Disproportionate complaints of discrimination may explain why ethnic minority status is a risk factor for mental illness. Conclusion: Management patterns laid down during the Imperial era continue to influence current practice for ethnic minority service personnel. Yet, armed forces can play a positive role in fostering diversity and integration to provide protective factors against mental illness.

They Called it Shell Shock: Combat Stress in the First World War By Stefanie Linden. Helion and Company Limited. 2016. £19.99 (hb). 272 pp. ISBN 9781911096351

The British Journal of Psychiatry, 2018

Moral injury in time of war

Lancet (London, England), May 5, 2018

Railway Suicides in the UK, risk factors and prevention strategies

Citing this paper Please note that where the full-text provided on King's Research Portal is ... more Citing this paper Please note that where the full-text provided on King's Research Portal is the Author Accepted Manuscript or Post-Print version this may differ from the final Published version. If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.

Extremism and common mental illness: cross-sectional community survey of White British and Pakistani men and women living in England

The British Journal of Psychiatry, 2019

BackgroundMental illnesses may explain vulnerability to develop extremist beliefs that can lead t... more BackgroundMental illnesses may explain vulnerability to develop extremist beliefs that can lead to violent protest and terrorism. Yet there is little evidence.AimsTo investigate the relationship between mental illnesses and extremist beliefs.MethodPopulation survey of 618 White British and Pakistani people in England. Extremism was assessed by an established measure of sympathies for violent protest and terrorism (SVPT). Respondents with any positive scores (showing sympathies) were compared with those with all negative scores. We calculated associations between extremist sympathies and ICD-10 diagnoses of depression and dysthymia, and symptoms of anxiety, personality difficulties, autism and post-traumatic stress. Also considered were demographics, life events, social assets, political engagement and criminal convictions.ResultsSVPT were more common in those with major depression with dysthymia (risk ratio 4.07, 95% CI 1.37–12.05, P = 0.01), symptoms of anxiety (risk ratio 1.09, 95...

Pathways to sympathies for violent protest and terrorism

The British journal of psychiatry : the journal of mental science, Dec 8, 2016

Radicalisation is proposed to explain why some individuals begin to support and take part in viol... more Radicalisation is proposed to explain why some individuals begin to support and take part in violent extremism. However, there is little empirical population research to inform prevention, and insufficient attention to the role of psychiatric vulnerabilities. To test the impact of depressive symptoms, adverse life events and political engagement on sympathies for violent protest and terrorism (SVPT). A cross-sectional survey of a representative sample of Pakistani and Bangladeshi men and women from two English cities. Weighted, multivariable, logistic regression yielded population estimates of association (odds ratio (OR) and 95% confidence intervals) against a binary outcome of SVPT derived from a three-group solution following cluster analysis. Depressive symptoms were associated with a higher risk of SVPT (OR = 2.59, 95% CI 1.59-4.23, P < 0.001), but mediated little of the overall effects of life events and political engagement, which were associated with a lower risk of SVPT ...

The role of doctors in investigation, prevention and treatment of torture

Journal of the Royal Society of Medicine, 2012

Summary Doctors may assess and treat torture survivors; some may document crucial evidence of tor... more Summary Doctors may assess and treat torture survivors; some may document crucial evidence of torture in medico-legal reports. However, there is a lack of education on torture and related ethical and legal issues at undergraduate and postgraduate level and many doctors are not aware of opportunities to work with organisations for the prevention of torture. This paper defines Torture, describes methods used, and sets out the human rights instruments and codes of ethical practice that mandate efforts to prevent torture. Medical complicity in torture is discussed and the need for national and international medical associations to prevent torture by both supporting doctors and recognising and tackling medial complicity. The paper offers guidance for assessing and documenting torture, and for providing health care for survivors of torture.

Trans-Generational Transmission of Traumatic Memory and Moral Injury

Military Behavioral Health, 2018

If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.

Battle for the mind: World War 1 and the birth of military psychiatry

Lancet, Jan 8, 2014

The 100th anniversary of the outbreak of World War 1 could be viewed as a tempting opportunity to... more The 100th anniversary of the outbreak of World War 1 could be viewed as a tempting opportunity to acknowledge the origins of military psychiatry and the start of a journey from psychological ignorance to enlightenment. However, the psychiatric legacy of the war is ambiguous. During World War 1, a new disorder (shellshock) and a new treatment (forward psychiatry) were introduced, but the former should not be thought of as the first recognition of what is now called post-traumatic stress disorder and the latter did not offer the solution to the management of psychiatric casualties, as was subsequently claimed. For this Series paper, we researched contemporary publications, classified military reports, and casualty returns to reassess the conventional narrative about the effect of shellshock on psychiatric practice. We conclude that the expression of distress by soldiers was culturally mediated and that patients with postcombat syndromes presented with symptom clusters and causal inter...

The Origins of British Military Psychiatry Before the First World War

War & Society, 2001

Military psychiatry in the United Kingdom is generally regarded as having begun in the First Worl... more Military psychiatry in the United Kingdom is generally regarded as having begun in the First World War'! Certainly, it then became an important service designed in the main to treat troops suffering from shell shock and battle exhaustion so that they could be returned to their units as quickly as possible. However, a significant developmental phase pre-dated this conflict when physicians were presented with servicemen suffering from a range of unexplained, somatic disorders, including Disordered Action of the Heart (DAH) and psychogenic rheumatism. These arose in a context of 'palpitation' seen during the Crimean War and irritable heart described by Da Costa in the American Civil War. In addition, military doctors encountered cases whose symptomatology suggested a neurological cause. These were both acute (cases of exhaustion after combat) and chronic (servicemen who remained debilitated for years after their discharge). Although the discipline of psychiatry remained embryonic in the UK divided between alienists, who treated so-called lunatics in asylums,2 and physicians with an interest in psychological matters, there was a small but growing debate about medically unexplained disorders. Neurasthenia and the phenomenon of railway spine tended to divide doctors into those who sought an organic explanation and those who interpreted these as psychological disorders. Furthermore, the rapidly filling asylums encouraged ideas of degeneracy in which the masses were wrecking civilisation with their mental imbecility or savagery, pre-Dr Edgar Jones was supported by a grant from the US Departnlent of Defense. Unless stated otherwise, all archival references are from the Public Record Office, Kew. 2.

Hearts, guts and minds

Journal of Psychosomatic Research, 2004

Objectives: To identify patterns of somatisation in army personnel diagnosed with postcombat synd... more Objectives: To identify patterns of somatisation in army personnel diagnosed with postcombat syndromes from the Boer War to the Gulf conflict. Methods: Using random samples of UK servicemen awarded war pensions, patterns of symptoms were compared and related to contemporary accounts. Results: Somatic symptoms continued to be common during and after World War II, suggesting that their decline was not great as claimed. Although psychological presentations increased, they did not supplant conversion disorders. Conclusion: Somatoform disorders did not disappear from the military in a smooth progression as society's understanding of psychological issues advanced. Rather there was a change in physical focus from the heart to the gut as new medical priorities arose.

A paradigm shift in the conceptualization of psychological trauma in the 20th century

Journal of Anxiety Disorders, 2007

The inclusion of posttraumatic stress disorder (PTSD) in DSM-III in 1980 represented a paradigm s... more The inclusion of posttraumatic stress disorder (PTSD) in DSM-III in 1980 represented a paradigm shift in the conceptualisation of post-trauma illness. Hitherto, a normal psychological reaction to a terrifying event was considered short-term and reversible. Long-term effects, characterized as ''traumatic neurosis'', were regarded as abnormal. Enduring symptoms were explained in terms of hereditary predisposition, early maladaptive experiences or a pre-existing psychiatric disorder. The event served merely as a trigger to something that existed or was waiting to emerge. Secondary gain, the benefits often but not solely financial that a person derived as a result of being ill, was considered the principal cause of any observed failure to recover. The recognition of PTSD reflected a diversion from the role of the group, in particular the ''herd instinct'', towards a greater appreciation of the individual's experience. From being the responsibility of the subject, traumatic illness became an external imposition and possibly a universal response to a terrifying and unexpected event. This shift from predisposition to the characteristics of the event itself reduced guilt and blame, while the undermining of secondary gain made it easier to award financial compensation.

‘The gut war’

History of the Human Sciences, 2012

Hospital admission and mortality statistics suggested that peptic ulcer reached a peak prevalence... more Hospital admission and mortality statistics suggested that peptic ulcer reached a peak prevalence in the mid-1950s. During the Second World War, against this background of serious and common pathology, an epidemic of dyspepsia afflicted both service personnel and civilians alike. In the absence of reliable diagnostic techniques, physicians struggled to distinguish between life-threatening illness and mild, temporary disorders. This article explores the context in which non-ulcer stomach conditions flourished. At a time when fear was considered defeatist and overt psychological disorder attracted stigma, both soldiers and civilians exposed to frightening events may have unconsciously translated their distress into gastrointestinal disorders. While the nature of army food was initially identified as the cause of duodenal ulcer in servicemen, the pre-war idea that conscientious and anxious individuals were at high risk gathered support and fed into post-war beliefs that this was a stre...

Civilian Morale During the Second World War: Responses to Air Raids Re-examined

Social History of Medicine, 2004

EDGAR JONES a , ROBIN WOOLVEN b , BILL DURODIÉ c , and SIMON WESSELY d SUMMARY. The impact of air... more EDGAR JONES a , ROBIN WOOLVEN b , BILL DURODIÉ c , and SIMON WESSELY d SUMMARY. The impact of air raids on civilian morale during the Second World War has been the subject of much dispute. Official histories concluded that the mental health of the nation may have improved, while panic was a rare phenomenon. Revisionist historians argued that psychiatric casualties were significantly higher than these accounts suggested because cases went unreported, while others were treated as organic disorders. Using contemporary assessments and medical literature, we sought to re-evaluate the psychological effect of bombing. There is little evidence to suggest that admissions for formal mental illness increased appreciably, although a question remains about the incidence of functional somatic disorders, such as non-ulcer dyspepsia and effort syndrome. The fact that civilians had little to gain from hospitalization in part explained why dire predictions of mass air-raid neurosis failed to materialize. In the event, civilians proved more resilient than planners had predicted, largely because they had underestimated their adaptability and resourcefulness, and because the lengthy conflict had involved so many in constructive participant roles.

The return of the traumatized army veteran: a qualitative study of UK ex-servicemen in the aftermath of war, 1945 to 2000

International Review of Psychiatry, 2019

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

The symptomatology of psychological trauma in the aftermath of war (1945-1980): UK army veterans, civilians and emergency responders

Psychological medicine, Jan 21, 2018

UK veterans suffering from a psychological or psychiatric illness as a consequence of service in ... more UK veterans suffering from a psychological or psychiatric illness as a consequence of service in the Second World War were entitled to a war pension. Their case files, which include regular medical assessments, are a valuable resource to investigate the nature, distribution and duration of symptoms. A standardised form was used to collect data from pension records of a random sample of 500 UK army veterans from the first presentation in the 1940s until 1980. Data were also gathered from 50 civilians and 54 emergency responders with a pension for post-traumatic illness following air-raids. The 10 most common symptoms reported by veterans were anxiety, depression, sleep problems, headache, irritability/anger, tremor/shaking, difficulty completing tasks, poor concentration, repeated fears and avoidance of social contact. Nine of the 10 were widely distributed across the veteran population when symptoms were ranked by the number of subjects who reported them. Nine symptoms persisted sig...

War Syndromes from 1900 to the Present: Symptom Patterns and Longterm Health Outcomes