Combat-related disorders: a persistent chimera

Whilst there may be some individuals who genuinely enjoy combat, for most troops it represents many emotional challenges, such as, overcoming fear and being witness to death, suffering and mutilation, as well as having to tolerate extremes of physical discomfort. At present we lack sufficiently valid and reliable methods of screening out those personnel particularly vulnerable to adverse reactions to these challenges. The authorities should aim to provide good training, an appreciative milieu, and a working climate in which those with genuine psychopathology feel confident to admit this, without censure and stigma, and to have access to evidence-based treatments. We should also remember that military life offers much to many men and women, and that surviving physically and psychologically the unavoidable brutalities of combat can often leave a legacy of positive outcomes. We must avoid becoming preoccupied with risk and psychopathology.