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 (

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,

Causing stigma by highlighting stigma? A lesson from Twitter

Russell Delderfield in the following blog post explores and problematises the issue of stigma and eating disorders, within the context of exchanges he had on the social media site Twitter. 

Russell D pic

Image by frankieleon (Creative Commons License) 

I have recently had the wind knocked out of my post-PhD prideful sails. I studied male eating disorders using qualitative approaches for my doctorate.

The issue of stigma arises constantly in the research I read and conduct. It feels as if there is no avoiding it. It is pervasive and un-ignorable. I cannot possibly ‘choose’ to set it aside and not engage with it. Yet, when it appears in psychological publications, the treatment of it (within my field, at least) is dissatisfying. The inferences seem to start from a hefty assumption: that ‘stigma’ is a coherent, unified ‘thing’. And more importantly, that it either exists – or doesn’t. In addition, there is a kind of unwritten imperative that I experience. This asserts that mining the data for its evidence about stigma and presenting this to the world is a good thing; it helps to hold it up to the light for further keen observation. And this is where our dilemma begins.

Let me backtrack and fill in some gaps at this point. Whilst I qualitatively explore  men’s experiences with eating disorder, I’m not entirely alone. There are other clinicians, psychologists and psychiatrists who investigate  male disordered eating. A small number of studies have been published that try to improve our understanding using qualitative methods (I count 6 in my collection, thus far). Although I do not profess to specifically examine stigma in male eating disorders (my interest is broader than this alone), some of my participants share stigma they encounter.

During my PhD, I wanted to address the cursory and superficial coverage of stigma that I perceived in other work. So, I did something that no other person has done (at least to my knowledge) within my field. I did not simply report on the existence of stigma and select some careful quotes from the data to illuminate what men had been through, I took the study of a couple of men’s experiences back to its ‘roots’, with a Bordo-esque exploration of what this stigma meant to these men. I explored stigma through the lens of spoiled identity. I asked, ‘What does it mean to the man to live with stigma?’, ‘What does the experience of stigma mean for a man’s masculine identity?’, and ‘What does the avoidance of stigma mean for a man’s masculine identity?’

This, for me, emulated the ethos of feminist eating disorder work where there is an established history of women and researchers sharing their stories of ‘spoiled’ identity, objectified womanhood and the meanings of what it is to be an anorexic, bulimic or binge-eating woman. I formulated a useful exposition of what spoiled masculinities mean and feel like for men living with an eating disorder. This went beyond simply saying ‘men report they experience stigma and here’s an example of the stigma they had to deal with.’ Finally, I was satisfied. This laudable and novel achievement was a source of pride. Job done (at least for now, I’m not naïve enough to believe that qualitative work is finite).

Well that was then, and this is now. Over the summer a fellow researcher tweeted about a BBC News report that asked why men who have eating disorders keep it a secret. I was straight on the case. I retweeted with my usual ‘awareness-raising-challenge-the-stigma’ gusto. In a painfully cropped 140 words, I said that stigma is one reason that men do not speak out. I tweeted that I knew this due to my qualitative research with the men themselves. I encouraged others to face-down this stigma that can be so debilitating.

And I was challenged in turn. One of the men who has an eating disorder, who follows my research on Twitter, contacted me to raise something that I had not thought of before. In my positively proselytising mission to campaign against the damaging effects of stigma (important as I still believe it is), I had overlooked something. One tweet was all it took:

twitter“I sometimes wonder if (only) talking about how men with EDs feel stigmatised teaches men with EDs that they should feel stigmatised…”

I was floored – both as a man with an eating disorder and a researcher.

I wonder how many men feel similarly? I wonder if it is true that holding a mirror to the nature and effects of stigma simply serves to perpetuate it? In my empowered role as researcher I had overlooked something that, once said, seems so obvious. How could I not have thought about this before? Am I part of the problem, instead of being one among many cogs of the solution?

I didn’t despair for long. My interlocutor and I had a thought-provoking exchange of views. I learnt something extremely valuable. This is the very substance of what critical psychology embraces: it acknowledges the fallibility of research because it is carried out by humans about humans for humans. It challenges the monadic perspective of psychology and the monolithic nature of published research studies.   In many ways, the fact that people actually respond to my research on Twitter, rather than just passively consuming it, means that my work finds meaning somewhere. Talking about my research findings with the public leads to dialogue and a shared understanding of my single researcher experience.

However, I’m still left with a dilemma. I accept the proposition in the tweet but I do not have an answer as to how do we erode the deleterious effects of stigma, if we do not highlight the concept and the role it purportedly plays in preventing men from getting help. As a researcher, I must make sense of the potential consequences of my findings. Is uncomplicated campaigning for improvement unequivocally beneficent? I thought so, but I don’t anymore. I set out to redress the lack of complexity in male eating disorders research when it comes to stigma (amongst many other things). In turn, this bred further complexity because it created an unforeseen conversation.

Unforeseen, but not unwelcome: it’s a lesson that I appreciated learning.

Dr Russell Delderfield
University of Bradford