Main Speakers:

• Lord John Alderdice, consultant psychiatrist, Alliance Party leader, and former speaker of the Northern Ireland Assembly (1998-2003)

• Mervyn Jess, reporter, BBC Northern Ireland

• Oscar Daly, psychiatrist, Board Member European Society for Traumatic Stress Studies (ESTSS)

Contents, Part 1:

Oscar Daly:

Recognising the impact

The paramilitaries

Vicarious traumisation

Mervyn Jess:

The Journalist's fuller understanding – and softening veneer

The Need for Recognition

Lord Alderdice

Different Stages of the Troubles

People want and need to close their eyes

» Go to part 2 ...

» Go to part 3 ...

» Go to part 4 ...

Mark Brayne: This promises to be an opportunity to eavesdrop on an intelligent and informed discussion between three very interesting individuals from Northern Ireland: Oscar Daly, psychiatrist with much experience of dealing with trauma, as it were, at the coalface; Mervyn Jess, one of Northern Ireland's most respected journalists working in the BBC newsroom; and Lord John Alderdice, former speaker of the Northern Ireland Assembly, Psychiatrist, and Psychotherapist.

Oscar Daly:

Thank you Mark. I suppose the first thing to say about Northern Ireland, certainly from my personal viewpoint is that – and some of my fellow speakers might disagree -there is no middle ground. When you look at Northern Ireland and what's happened over the last 30 years, you look from one or the other's perspective, either Catholic, Nationalist/Republican, Protestant, Unionist, Loyalist.

There's a story about a young Indian boy who was in Belfast one day. He was lost and met a group of young thugs. The first thing you do in Northern Ireland is you find out what religion the other person is, so they're either your side or the other side. They asked the young boy, ‘What religion are you, boy?' And he said, ‘I'm a Hindu,' and they said, ‘Yes, but are you a Catholic or a Protestant Hindu?' So, talking about Northern Ireland, I think it's important to keep that in perspective.

One man's terrorist is another man's freedom fighter. And when we talk about people who have been affected by the Troubles in Northern Ireland, there is talk about a hierarchy of victims. Many people would say that those who've been injured by terrorists, by paramilitaries on either side, are more deserving of care and treatment than those who've been injured by security forces.

Recognising the impact

Now the prevailing view until relatively recently was that the Troubles hadn't affected people psychologically. And that was probably the view until the Ceasefires. I feel that that's a mistaken view and there are a number of reasons as to why that might have been.

Looking at it from an individual point of view, people who are traumatised psychologically, for many, many reasons, don't attend for treatment.

First of all there's, the stigma associated with any type of psychiatric illness. Leaving trauma to one side - and this is probably a universal phenomenon - people who have psychiatric problems don't tell their doctor because they might feel that they'll be viewed as weak.

Looking specifically at trauma, the symptoms that people get after they've been traumatised include things like avoidance; somebody's been in a bomb explosion, for example, the last thing they want to do is talk about it; they don't want to think about it so they're not going to see their doctor, they're not going to seek treatment. People who've become depressed – one of the symptoms of depression is lack of motivation, lack of energy – they're not going to go and seek help.

Some people have a phobia about going out. In Northern Ireland in particular, the Troubles , by and large, have affected people in the lower socio-economic groups. It happens everywhere in civil conflict. In Northern Ireland, by and large, it's been an urban phenomenon, apart from certain rural pockets. So people stay in their own ghettoes and they don't leave to go and seek treatment.

As well as that, there's a certain lack of trust that applies to health professionals as well. Even though we like to think we're completely down the middle, we are very often viewed – especially by former paramilitaries - as being part of the state bureaucracy. As a doctor, I'm obliged, if someone tells me of a serious crime, to inform the authorities. Paramilitaries - former paramilitaries - know that, and so they won't go to the statutory authorities to seek help.

As well as that, I think many health professionals themselves have great difficulty in dealing with these problems. It's very distressing for an individual to come along and talk about how they've been traumatised by a bomb explosion, a shooting, a kidnapping or whatever; it can be equally distressing for the health professionals themselves to deal with these things. Doctors in general are not very good at looking at psychiatric problems or treating them. And specifically when it's related to psychiatric trauma, they're even worse. So there's a tendency for doctors to concentrate on physical problems rather than talk about psychological problems.

There is the other issue as well about the political nature of the violence. For many GPs, if they're treating someone form the other side of the community, there is that sort of barrier, and that applies, I suppose, to psychiatrists and psychiatric nurses as well. That barrier, first of all, has to be overcome before you can move on to treat people.

Particular groups of people have been affected. We don't know what the Troubles are going to be, long term, in children. No-one under the age of nearly 40 now would have known a childhood without the Troubles . This has been going on for 20-25 years and in some areas, particularly in Belfast there would have been rioting on a regular basis –shootings, bombings and so on. We just have no idea what the long-term effects are. Do children habituate and do they cope with these things, or is there a sort of cumulative adverse effect upon their psychological health? We don't know. And on a social scale, when children in a particular community see others in that community flouting the law, rioting, showing disrespect for the authorities – what effect, long-term is that going to have on the kids? As I say, we just don't know but I can't imagine it can be healthy.

What about members of the Security Forces? Again, this is a particular group that maybe people have not responded to. If you talk about British soldiers, the first research paper done on how British soldiers were affected by the Troubles that I have come across - and I've looked very extensively at this - was in the British Medical Journal last year. So even though for much of the last 30, 35 years Northern Ireland was the only field of combat for the British Army, there was no research done, whatsoever.

Talking about locally-recruited security forces, the police and the locally-recruited residents of the British Army, they are in an even more difficult position. Whereas the British Army went back to their barracks, and then after a term of duty went back to mainland UK, the police and the locally-recruited soldiers did not. So they were never, in a sense, out of the front line. When they were at home, when they were off-duty, they were still at the risk of assassination, of being killed.

And the conflict in Northern Ireland is something for which certainly, British soldiers had not been properly trained. There is a place called Tin City where they got six or eight weeks' training in a sort of makeshift urban area. But soldiers are trained, by and large, to kill. And in Northern Ireland, the sort of policing they have been required to do, is something they're not trained for. So they have this high level of adrenalin, ready to go, ready to get involved in what soldiers are trained to do, and yet very often they're not allowed. They're walking down the street and any individual could be either friend or foe; so these are particular difficulties. I think, as time goes on, there are more and more soldiers coming with problems.

Since the Ceasefires, the police, in particular, have been coming along for treatment much more so than they ever did before. And this is because since the Ceasefires there's been relative peace, so they've had the opportunity to let their guard down, where during the Troubles they just couldn't. I've had people coming along to me for treatment and they say, ‘Okay, well I have this symptom and I want you to treat this symptom and this symptom; I don't want you to treat the hyper-vigilance, I don't want you to treat the sleep disturbance because I want to be ready when they come the next time.' So it creates difficulties for you when you're trying to treat people.

The paramilitaries

The other couple of groups of people who are maybe not thought much about what I suppose you can describe as combatants, the paramilitaries, or whatever you want to call them. As I said earlier, there is what many would view as a hierarchy of victims. For people particularly on the Nationalist side, they would try and tell you that because society in Northern Ireland is abnormal, everyone in Northern Ireland is a victim. If you take that attitude, it does absolve people from the responsibility of getting involved. People who have got involved in the paramilitaries have made a conscious decision to become involved, whereas the fellow next door to them who was subject to the same difficulties, abuse or whatever, didn't get involved; so it is a personal decision.

Many of those people when imprisoned have difficulties in coping with prison, but more so when they come out after maybe 15 years in a cell, sleeping on their own. Then they come out and go home, and try and pick up the pieces of their life. It can be very difficult. They have difficulties with relationships, with getting work and so on, and a number of people subsequently develop guilt as well for the conflict or the actions in which they've been involved. As I said, they can't really come to health professionals about that, so there are a number of groups set up to help them – help ex-paramilitaries.

Vicarious traumisation

And the final group of people who are not usually considered are those who have been vicariously traumatised. That includes health professionals who have worked in casualty departments on a nightly basis, with people coming in very badly injured. It includes emergency personnel, ambulance men, firemen and also perhaps, journalists. I think journalists who report regularly on incidents can themselves reach a certain level where the bottle becomes full, and they just can't cope any more after the accumulation of covering so many traumatic incidents.

Finally, I'd like to say that over the last 30 years there's been very, very little reporting on the psychological aspects of the Troubles at home; very, very little reporting by journalists and very, very little research carried out by health professionals. I think that's something we could maybe talk about in the discussion later on.

Mervyn Jess:

Good evening, ladies and gentlemen, and thank you for the invitation. When I got the invitation to speak here this evening, I had to think long and hard about what it was I was going to say because as you probably are well aware, journalists are not that forthcoming when it comes to talking about themselves. We like talking about somebody else and their problems, but talking about our own problems is a bit like trying to crack a very hard nut.

I'm going to talk from the point of view of experience, from the heart, as a journalist. And these are my own views, nobody else's.

There's been a lot of talk lately about a Truth Commission in Northern Ireland, and I'm sure we'll come on to that later in the general discussion. South Africa has been used as an example of how to work out the problems that people still have after 30 odd years of conflict, killing, mayhem and maiming. The problem with a Truth Commission is the title itself. Truth – whose truth? What is the truth? As Oscar mentioned earlier, one person's terrorist is another person's freedom fighter, so immediately you've got a conflict on what is the truth.

And there's a history problem with Northern Ireland, and there's a geography problem. We have a history going back hundreds of years. And we've got a geography problem, where so many people who've got problems with each other are living cheek by jowl, side by side, and the only thing that's keeping them apart is a 150-foot concrete wall with barbed wire on the top. I'm exaggerating a little bit but that's what it boils down to.

We've seen pictures of Berlin when the Wall came down, and how symbolic that was and what it meant to East and West Germany. Well, before any walls come down in Belfast, the walls that have to be brought down first are the walls in are the minds of the people who live there. They will have to live with each other, trust each other, get on with each other, and at the moment there's little evidence of that mindset changing - to the extent where we might see, on television and the news programmes, walls tumbling around Belfast north, south, east or west.

One of the single, most affecting moments of the Good Friday, or Belfast Agreement (of 1998) I think, was, probably, the early release of prisoners, both Republican and loyalist paramilitaries. It drove a stake into the hearts of many families, especially the families of those who lost loved ones during the Troubles . And we had to deal with the outpouring of grief from that side of the equation, and we also had to deal with the outpouring of relief on the other side of the equation, where families were welcoming back into the fold loved ones who had been facing, up to that time, life sentences for some of the most atrocious crimes you can imagine being committed.

But it was part of the agreement; it was signed, it was agreed, it had to be. People have been getting over that; we've had to be listening to everything they feel about that since the first prisoners were released.

You say, it's good to talk; in our job, it's good to listen. But the listening carries with it a burden and a responsibility, and also an impact; and we have been feeling the impact from both sides. Trying to get the story out with balance and impartiality and fairness, and at the same time, not being overly affected by what it is people are trying to tell us. And some of the stories they've told us over the years have been harrowing. Anybody who has worked in any sort of war zone can tell you that, and if you're there when it happens, it's even more harrowing.

The Journalist's fuller understanding – and softening veneer

The journalist in Northern Ireland has a fuller understanding, I think, of what's going on than journalists in many other parts of the world - because they've actually lived there, they're born there, they're bred there and they're rearing a family there. So they're meeting and talking to people on both sides of the conflict, daily. And I think we understand where both sides are coming from. The problem is, we don't understand fully our role in the whole thing beyond reporting the story. That's been an issue, I think, for a lot of people throughout the years. We understand what you're saying, I understand what you're saying; I understand our reporters, but I don't really understand my role beyond that.

And there is a role here because we do affect people's lives; we affect what they say. We put a camera in front of them in a highly charged situation – we automatically are going to affect what they say because they wouldn't have said that without the camera being there and without me, or somebody like me, asking them a question. And the question I ask is a question that I've thought of asking them. So we do have an impact, and we are still working out what that is and where we go with that from here in a ‘post-' – advisedly used – conflict situation.

We have a veneer; if you like it's a thin, rather hard veneer over most of the journalists that work in Northern Ireland, local journalists especially who live and work there. And that veneer is to stop it getting to you, because you feel if it gets to you, it's going to tarnish, in some way, how it is you tell the story. So the story won't be as truthful or as accurate or as fair as it should be. And I think – and this is me speaking really personally now – that since the Ceasefires and the drop-off in the violence, there has been a lessening and a softening of that veneer.

I'll give you an example; this happened to me about four weeks ago. There was a murder in East Belfast. It was a loyalist/paramilitary feud; one group of Loyalist Paramilitaries shot dead a guy who was leading another group of paramilitaries. We got a tip off from an ambulance driver. We were there immediately behind the ambulance, and I and the cameraman were physically running up the road behind them as they were going to the car, which was parked outside this man's work place. We set the camera up by the paramedics desperately trying to revive him and keep him alive - and they failed.

But while I was running up the road with the cameraman - and I've covered countless murders and explosions over the years - I was experiencing something that I hadn't experienced very much over the last 30 years, and that was a feeling of, ‘I thought this was all over! I didn't think I would be going out to cover this type of story again.' This was immediately followed up by another thought, which was, ‘What do I do now?'

That passed within a second, and experience clicked in and took over and I got on with the job And we did the job and carried on but, just for a second, I could hear the sound - the gentle sound - of air escaping from this pressure cooker which had been screwed down so tight for so many years on all those little demons, to keep all that at bay. I reckon that was a consequence of so many years since the day of the (Good Friday) agreement of not having daily killings and murders.

It's a shock when it happens like that, because immediately I could feel my sub-conscious hand screwing that lid right back down on again, just to keep all that emotion, that humanity compressed back in to the pot. We're trying to get at the humanity behind the statistics of the deaths and the murders in Northern Ireland on whatever side, and doing that, I think we try consciously to keep our own humanity at bay because we feel it might in some way make us more subjective about the way we would cover the story.

That also leads to a bigger question; at some stage you might ask yourself this one: ‘What the hell am I doing here?' And that's the most frightening question any journalist in Northern Ireland can ask themselves, because we should be doing the job because we want to do it. We must have a reason for wanting to do it and if we have come to the point where we're asking ourselves - ‘What the hell am I doing here?' – it sort of negates what you've been doing for the last 20 odd years.

So I feel there's a great conflict going on in journalists' minds – those in particular who have lived, breathed, worked through the Troubles of the last thirty years, have seen it all happening and have got the T-shirt.

The Need for Recognition

I think also, there is a conflict within journalism that is about recognition. I don't mean recognition in the way of – ‘You're a great guy, you're a great girl and here's a gong and there's an award and you're the journalist of the year' and that sort of stuff. A lot of journalists are in denial about this, but there's a lack of recognition from, perhaps, their employers, their friends and family, and maybe the public at large, because since the Good Friday Agreement things have moved on that quickly. Things moved on at speed and all of a sudden, all those who have been covering the bombs, the bullets and the blood were left behind, and a whole new era of reporting took over – which was all about politics and rebuilding and investment and the future. And those who had been doing the daily grind, if you like, to an extent, felt forgotten.

Now you ask me how you get round that – I don't know. Perhaps it's enough to live on and work on with the knowledge that at least you yourself recognise that, but being the cynics that we generally are in journalism, you know you're never going to get everything that you're expecting to get. So you just say to yourself, ‘Well, I'm living with it, I'm getting on with it, we're carrying a bit of a weight here because of what happened over thirty years but at least we're moving forward.

Lord Alderdice

Thanks very much Mervyn and Oscar, and Mark for the invitation to come along.

Different Stages of the Troubles

There are one or two general comments I'd like to make about the situation in Northern Ireland. First is a very obvious one, but it gets forgotten a lot. And that is, that the period of the Troubles, as we call them, was not a constant kind of period. There were very different kinds of violence at different stages. In the early stages there was a lot of street violence, a lot of people out on the streets, riots and things of that kind. Now, while we still get the occasional street activity, as we did this past week, it's absolutely minimal in comparison with what we saw in the early 1970s.

We moved on to a period of time where there was widespread bombing, car bombs blowing up town centres and all sorts of things like that. Then we moved on to a period where there were much more targeted bombings and assassinations and shootings. And that was very different, because if you were a parent with teenage children, during the first stage you were worried that they were out getting into trouble; during the second stage you were worried that they might get caught up - you'd be down the pub and the pub would get blown up. When it came to the third stage it was a different kind of sense; it would be a much more accidental thing that they might be caught up in it. It might be much more likely if they joined the police or various security forces or they got involved in paramilitary organisations.

So one can't look at that whole period and see it as a homogeneous period; it's not. I think it likely that the psychological impact of the different stages would have been rather different on different people.

The second thing is that the observation that Oscar made, which is absolutely correct, that it is remarkable how little work has been done in the area of psychological impact of trauma.

Now Mark was commenting at the start that there weren't a huge number of people here for this discussion; I'm completely unsurprised, because my perception of it is that there is quite a resistance to looking at these kinds of things. I'll give you an example from a completely different area. About two weeks ago I was in Ayacucho up in the Andes in Peru where (the) Shining Path (guerrilla movement) started and about 70,000 people were ‘disappeared' either by the Military or Shining Path or other groups. And a lot of those people are buried in something like 4,000 mass graves throughout Peru – about 2,000 or so in the area where I was up.

Now they've started finding some of these and digging them up and I was along at a sort of ceremony, I suppose you'd describe it, where five sets of remains were being handed back to the families who had come down to the mortuary. This was, I think, only the fourth handover of remains since this work started a couple of years ago.

The remains were in coffins, and we moved on to a kind of parade or procession through Ayacucho itself, which was the centre of all this when it started. Indeed there was a riot there a week or so ago about some of the underlying problems. As we walked through, the mayor met us at the town hall, there was a band playing, and so on – but almost nobody in the town paid any attention to what was happening.

To me that was very striking, because if you have an ordinary funeral without any paraphernalia, a single coffin going through the street, you'll generally find, particularly in rural communities or semi-rural communities, people will stop and they'll touch their hat or something like that. Here were five coffins coming through; a lot of publicity about why it had happened, very clear about what it was related to, a band playing, local officials out – nobody wanted to pay any attention.

People want and need to close their eyes

Now there's only one real explanation for that, and that is that people wanted to close their eyes to it. They didn't want all of this to be raised, they wanted to get on with things. And there's an important question about why that is. Is it the question about stigma and machismo and all those things? Well, maybe there were elements of that but I think it's a much more difficult problem than that, and it is that when Troubles ome things arise, the main job for us is to try and get over it and get on with life. For quite a lot of the time we can do that remarkably successfully. That's one of the striking things: how successfully we can put a lot of worrying things to the side and just get on with our lives. That's a necessary function.

For example, if you're a surgeon and you think too much about exactly what you're doing, you could never perform an operation. I have a friend who used to work out in Malawi. His wife was pregnant, she needed a caesarean operation; he was a doctor, she was the only nurse, and there was nobody else for a few hundred miles so he had to do the caesarean operation on her without proper anaesthesia. And it was his own wife and his own child. Now if he starts thinking too much about exactly what is going on there he would never get through it, he wouldn't be able to do it.

So we've got to have the facility to keep certain things at bay. And if you're working in a situation of violence and difficulty, as Mervyn has pointed out, if you keep thinking about these things all the time, you're in difficulties.

In fact, that's a dilemma that's around for us all when we're working with psychological problems; and it is this. You can either think about things or act on them. But it's very difficult to do both. If you're in a fight, you can't do what Mervyn was suggesting there - start thinking about it and wondering and reflecting. That's not what we train soldiers to do. We train them to do what they're told and get on with it, and any apparent thinking that gets done is largely a rationalising of why I'm on this side or the other side; it's rarely a reflective piece of thinking.

It's one of the problems of current politics that it is all about reacting. Most of the words that are spoken are not spoken on the basis of thought and reflection, they're spoken on the basis of campaign and ‘Argue my case', not of thinking, ‘Why am I saying this? What is going on?' Because when you start to do that, when you reflect and you think about things, it's much more difficult to act on because you can see a lot more of the implications of these things.

For example, when Oscar was saying that one man's terrorist is another man's freedom fighter, that's because the word terrorist is used not to describe a particular tactic - which is what it is - but is used with a moral loading. A lot of the way we talk about violence obscures our capacity to understand it, because we moralise about it. One of our colleagues, James Gilligan, is a psychiatrist in the United States who has worked with a lot of very mentally disturbed, extremely violent people. He's done a lot of work on taking that moral component out, simply trying to understand this as you would try to understand another public health problem. In other words, think about violence as though it was an infection, or cancer, or something of that kind. Stop moralising about it and try and understand what's at the back of it.

It's very difficult when you're in a violent situation, because it's very hard to not be on one side of the argument or the other. If somebody is having a debate you may be able to hold it. But if I hit Mervyn, and Mervyn hits me back, before very long you'll find yourself taking sides and stepping in and acting rather than reflecting on how this whole thing came about. Violence creates a dynamic of its own, which is much more than disagreement and difference.

So we've got this dilemma that there's a tendency to not look, not reflect on what's going on. Not just because it's inconvenient, but because it's actually an internal problem, a real struggle, to do it. When people have tried to look, they very often run up against difficulties,. People don't want to talk about these things. Some of the reasons why people don't want to talk are because they have genuine fears about what might be done with the information, as Oscar said, but there are also lots of other reasons.

If you ask yourself too many questions about what you did as a paramilitary or as a policeman, you run into difficulties. I think one of the problems that we currently have with members of the security forces beginning to exhibit symptoms that they didn't during the period of the violence is some of them come along and they say, ‘What the devil was all that about? Why did we do it? Why was I at risk? Why was my family put through the mill? Why did so many of my friends and colleagues die? Nothing was sorted out by all of this.' There's this huge existential question in all that, as well as a psychological problem.

Then of course, not only was there a difference between different faces of the violence but there was also a difference as to why different people get involved in the violence. There was an idea around for a period of time that you could create some kind of notion of a terrorist personality, a kind of person that would get involved, just the same as there was an idea that you could do this in terms of people with a fascist disposition or particular states that had a particular political approach. And it's not true! People get involved in terrorism for a lot of completely different reasons.

» Go to part 2 ...

» Go to part 3 ...

» Go to part 4 ...