Edgar Jones

Summary: During the Cold War, leaders with combat experience engaged in attritional bargaining over territory and arms limitation with groups of advisors to offer pluralistic opinions. Hegemonic leaders today exhibit little tolerance for diverse interpretations and appear less likely to consider analogies informed by international law and codes of conduct.

Objectives: To assess physical and mental symptoms by ethnicity of a UK Armed Forces cohort. Design: A retrospective, pooled cross-sectional analysis. Setting: Self-report questionnaire collected between 2004–2023. Participants: Three samples of UK Armed Forces, including a Gurkha (n=254), Fijian (n=112) and a heterogeneous sample of British ethnic minority personnel (n=178) were compared with a sample of white British participants (n=254). Main exposure measure: Physical and mental health symptoms were measured using individual items from the Patient Health Questionnaire, Post-traumatic Stress Checklist (Post-Traumatic Stress Disorder Checklist—Civilian Version) and General Health Questionnaire (GHQ-12) drawn from four phases of cohort data. Ethnic samples were matched by military role and veteran or active service status. Results: Based on their first assessment, 60 white British participants (24.2%) met GHQ criteria for common mental disorder, significantly higher than found for the other three groups (χ ² (3, n = 782) = 25.03, p<0.001). Across all measures, Gurkha participants were the least symptomatic, though Gurkha and Fijian participants reported more symptoms of post-traumatic stress. British samples reported more somatic reports. Different patterns of post-traumatic and somatic symptoms may be explained by differential levels of traumatic exposures, recruitment profiles and culturally nuanced expressions of distress. Conclusions: Patterns of mental and physical symptoms warrant further investigation to inform prevention, more precise diagnosis and tailored care and treatment for specific ethnic groups.

A significant challenge faced by the British Army during the First World War was how to manage large-scale psychological casualties in a context of increasing manpower shortages. The high numbers threatened to undermine the fighting strength of the British Expeditionary Force and prompted the introduction of standardized regulations and treatment programmes. Fundamental disagreements about their design arose between three groups: senior regular medical officers, civilian specialists who had volunteered for Territorial or wartime service, and the generals responsible for the conduct of the war. A fierce debate arose between those who believed that medical expertise should drive casualty policy and those who thought that military goals were paramount. With growing shortages of replacement troops, shell shock was increasingly framed as a manpower issue in France to retain as many soldiers as possible on the frontline, reducing the authority of specialist clinicians. A growing realism of what could be endured in the trenches and what could be achieved by the treatment of severe cases informed different policies overseas and at home. The War Office Committee of Inquiry set up in 1920 was a tacit admission that the challenges created by the recognition of shell shock had not been solved during the conflict.

Summary: Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.

The UK has seen an outbreak of riots after the death of three children in a knife attack. Misinformation about the suspect's heritage and religion was spread by social media, which was then used to incite violence and racism resulting in damage to property, terror and injuries. We put forward arguments that this was an extremist act and draw on the literature on terrorism, extremism and identity to put forward a deeper analysis of how this happened and what can be done to prevent future riots. We bring an interdisciplinary perspective drawing on research from social, cultural, psychological and political perspectives.

Soldiers Don't Go Mad: A Story of Brotherhood, Poetry and Mental Illness During the First World War. By Charles Glass. Bedford Square Publishers. 2023. £16.49 (hb). 352 pp. ISBN 978-1835010150. - Volume 225 Issue 4

This review aimed to explore individual-level factors involved in radicalization and the impact of moral injury on an individual’s beliefs and behaviors that are relevant to radicalization. The results indicate that both individuals who develop radical beliefs and those with moral injury are exposed to events which provoke similar adverse outcomes, including a loss of personal significance, suggesting that moral injury could be a useful way to understand the process of radicalization. Understanding the processes involved in moral injury may inform preventative programs, as well programs to promote disengagement from radical action in those who have already been radicalized.