British prisoners-of-war: from resilience to psychological vulnerability: reality or perception

In contemporary culture, soldiers held as prisoners-of-war (POWs) or as hostages are considered at significant risk of mental illness, in particular post-traumatic stress disorder (PTSD). This assumption contrasts with the psychiatric orthodoxy of the First World War when it was concluded in both Britain and Germany that POWs were protected against 'war neurosis'. Although 'barbed wire disease' was identified during time of captivity, post-release effects were not recognized. The repatriation of 'protected' POWs in 1943 prompted a reassessment of the psychological impact of imprisonment when servicemen of previous good character began to behave aberrantly. Rehabilitation programmes were designed to enable soldiers to re-adapt to service or civilian roles. Difficulties of adjustment were cast in social and cognitive terms, and corrective measures were occupational and educational. Psychiatric disorders found in POWs were explained in terms of a pre-conflict predisposition to, or a history of, mental illness. However, retrospective studies of veteran POWs have found a high prevalence of PTSD. A change in attitudes is explored in relation to the advance of medical terminology into the territory of emotions and the attribution of pathological processes to self-recovering mental states. The reclassification of the effects of imprisonment implies that diagnoses in military psychiatry are culturally determined and can be understood only if they are placed in a context that includes changing beliefs about mental illness, the formal development of the psychiatric profession and the immediate needs of the armed forces.