How sport and exercise helps veterans heal – and how it can do it better

To open 2018 we have a critical piece exploring research, interventions and mainstream narratives within Western cultures surrounding sport, exercise and war veterans. UK-based Nick Caddick critiques and overviews the current state of knowledge and approach to treatment of veterans, and follows this up with some innovative suggestions on how to move things forward at an individual and societal level in order to facilitate veterans’ healing and wellbeing. Thanks for reading and happy new year. (Dee Lister and Neda Mahmoodi, your ISCHP Website and Blog Editors)

 

By Nick Caddick (nick.caddick@anglia.ac.uk)

There’s a new story unfolding about how veterans are healing from the physical and psychological damage of war. Or rather, a new chapter in an older story. The birth of Paralympic sport over 60 years ago was stimulated by the need to rehabilitate wounded Servicemen. And the evidence suggests it had many rehabilitative benefits. Today, the use of sporting and other pursuits – surfing, sailing, fishing, skiing, archaeology, and the recent Invictus phenomenon, to name but a few – is expanding as a means of supporting veterans.

These activities have started to take hold as an approach to helping veterans deal with “PTSD”; the medicalised, disorder-focused label by which we denote what can be more simply understood as the psychological turmoil that sometimes follows encounters with deeply scarring and frightful situations. Healing for physical injuries – most notably in the case of war amputation – also increasingly follows a sports-based model of recovery.

A large network of military charities has been at the forefront of this ‘alternative’ approach to helping veterans. These charities have been well-funded – at least during the wars in Iraq and Afghanistan – and have supplied the British public with no shortage of stories about veterans overcoming their disabilities through medal-winning competition, or battling the demons that haunt them.

One question to pose is why some veterans are turning to sport and exercise – and other ‘non-medical’ approaches – to help them deal with the traumas of war? And, similarly, what are they finding in such approaches that they do not get from the clinical therapies often favoured as the ‘gold standard’ treatments?

I recently reviewed a mounting body of evidence regarding the impact of sport and exercise-based approaches to helping veterans. This included benefits that were integral to the activities, such as the restorative psychological benefits of being active in nature, and those that were more incidental, such as the powerful dynamics of peer support and challenging mental health stigma through a ‘positive’ and ‘proactive’ method of dealing with issues. The benefits are real, wide-ranging, and call out to be acknowledged.

Contestation and control

Yet, in what Herman and Yarwood1 refer to as the “politicised terrain of post-transition welfare”, such findings are sometimes contested. Psychiatry, for example, tells a different story; that only the NICE-approved clinical therapies are fully supported by evidence and should be used to help veterans, particularly with regard to mental ill-health. This is a powerful story – with the weight of medical scientific discourse behind it – and it tends to push other voices to the margins. And being marginalised hurts the pockets of the smaller charities providing these ‘alternative’ approaches to supporting veterans.

So, we have arrived at a situation whereby it is in the interests of charities to shout loudest that ‘their’ approach works best or has the best outcomes. The clinical approaches do, of course, work for some, but even here the evidence is sometimes overstated. In the crowded space of the military third sector, with strong competition for control of resources and authority, overstatement of evidence is a problem which sometimes leads on to proselytizing and to over-dramatized stories of veterans’ heroic transformations. A more sober assessment of evidence, without the inflated patriotism, heroism, and ubiquitous ‘inspiration’ is certainly needed.

Doing things better

The evidence does suggest that sport, exercise and a range of other pursuits can be meaningfully beneficial to veterans in dealing with physical injury and psychological suffering. I wish to suggest three ways in which this can be done better.

A balanced assessment

Just like the clinical approaches, sports and other activities are no panacea for recovery in mental ill-health or for transformational physical rehabilitation. Each approach has its benefits and its limitations, and these need to be acknowledged. For instance, when someone is in the darkest depths of depression, it can take an enormous effort of the will simply to rouse the energy to face the day, let alone force oneself into a freezing wetsuit and go surfing. Yet, for the veterans with whom I worked at charity Surf Action, surfing was something that made life worth living in the aftermath of war. That’s a powerful story, and it calls out for our attention and respect. But we must also be mindful not to oversell the message. Further research is needed to broaden the evidence base for a range of activities; a case I set out in detail in my recent article.

Drop the populism

The messages surrounding veterans’ participation in sports events and other activities often promote uncritically a populist discourse of military heroism. The message, amplified by the media, is that of ‘our’ brave and heroic soldiers inspiring the nation by continuing a personal fight away from the battlefield. Similar to how the ‘support the troops’ discourse worked during Iraq and Afghanistan to obfuscate criticism of these wars, the populist message can be seen as one way of excusing governments of responsibility for veterans’ injuries and illnesses by focusing instead on their triumph and redemption. Moreover, the populist discourse too easily traps veterans in a story of dramatically ‘overcoming’ illness and injury. The danger is that this doesn’t allow veterans to become civilians, or even just ordinary people, in the same way Paralympic sport sometimes positions athletes in the exclusionary identity of ‘super-crips’. We need to promote the benefits of sporting and other pursuits without the ‘inspirational’ populist messages. Doing so might better enable the charities to focus on a common purpose of supporting veterans in transitioning to healthy and productive civilian lives.

Take the long view

Sport can be a powerful tool for recovery, as Prince Harry has argued in relation to Invictus. But we also need to look well beyond the initial ‘post-transition’ phase of rehabilitation and support. Veterans’ long-term future in civilian life may well be served better by funnelling resources into their education and career development, for instance. My latest research with colleagues from Northumbria University explores the narratives of older limbless veterans in relation to the challenges of ageing with limb-loss. For these veterans, years of wear and tear on their remaining limbs – along with comorbidities such as arthritis and low back pain – create an ongoing struggle to maintain a sense of independence. As well as a ‘get on with it’ approach to dealing with pain and hardship, these veterans stressed the need for more mundane yet purposeful activity – photography was a popular one – to keep them engaged and provide structure to their daily lives. Also highlighted was the importance of a telling a positive career story post-injury; something that brought a sense of continuity to their post-injury lives. There are, therefore, other things besides glamorous and well-publicised sporting opportunities to consider in terms of rehabilitation and recovery.

There are finite resources – shrinking resources, now there is no war on – for supporting veteran communities. It matters how we use them. Sport, exercise, and various other pursuits clearly have a role to play. It’s time to consider how we can make that sustainable.

1Herman, A., & Yarwood, R. (2015; p. 2640). From warfare to welfare: veterans, military charities and the blurred spatiality of post-service welfare in the United Kingdom. Environment and Planning A, 47,

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