This is an edited transcript ...

Mark Brayne:

… So, what impact is the trauma of this conflict now having on those who are fighting it? Why are combatants on both sides behaving the way they are? What are the longer-term psychological implications for the region and the broader international community – for the military, for governments, for society and the media? What is the psychological damage of the Iraq conflict: fighting, living, reporting, and governing.

Conflict is driven by psychology; as journalists we are very good at reporting symptoms and external causes; economics, politics and all the rest of it. What I don't think journalism does at all adequately yet, nor does the political discourse, is to reflect what is happening in the hearts and minds of individuals who are responsible for creating conditions that lead to conflict; whether it's in a responding to conflict, or a generating conflict mode ...

So, if we could start with Simon Wessely, one of the best speakers I know on these issues. I've seen him at work at Traumatic Stress Study Seminars on a number of occasions and he has worked, and continues to work, very closely with the British Military and the Ministry of Defence. He was one of the key advisors to the MoD in the class action in the court case around British military veterans claiming for compensation for not having been adequately supported or trained around issues of trauma in the Falklands, The Gulf War and Bosnia.

Simon is with the Institute of Psychiatry and King's College, London …

Simon Wessely:

… I'm the Psychiatric Advisor to the British Army so I'm not neutral on this subject. I also run the King's Centre for Military Health Research, which is carrying out a lot of research in this area.

Now Mark sent me an email this morning and it says something like: What I'd like you to do Simon is go first, brief introduction to the take on Psychology of Conflict, what drives it, why fighters behave the way they do on both sides and what is the impact on those who take part and what will happen to them afterwards? Well, that would take about five years so I'm not going to do that. Instead I really do want to talk on two subjects, both of which are somewhat close to my heart.

One is really about why people fight - why men fight (it largely is men, though not entirely), why they fight; and tiny little bits about how that relates both to what's happening in Iraq and why the British Army fight there.

Now the reason I'm going to start there is because I recently attended a workshop organised by NATO on the topic of suicide bombing; it took place in Lisbon on the 10 th June.

I was there to talk about the simple question – ‘Are suicide bombers mentally ill?' To which the answer is, ‘No.' There's a large and increasing literature on this subject; on the particular subject of what drives suicide bombing, which is obviously a crucial element in Iraq and around the world at the moment. About the one thing we can say, with complete conviction, is that whatever else people who do these acts are, they are not suffering from mental illness.

I know they may be a selective group, but based on Palestinian and Israeli interrogation records of about 60 people who were caught - some of them give up, for others the equipment didn't work or whatever - and a larger group were studied after death, suicide bombers are not mentally ill, and many are remarkably robust. Indeed, as far as I know, with one exception, there's no documented history of a suicide bombing involving someone with a history of mental illness. Sometimes these people are misfits, not necessarily well integrated in school or family, but mentally ill they are not.

Now that raises the question, of course, as to what exactly was going on? I had an unenviable task at the NATO meeting. I was followed by a rather young looking White House lead on Counter-Terrorism. First of all, he completely refused to call these people ‘suicide bombers.' He called them homicide bombers,' which again is not accurate, in the sense that the essence of what they are doing is about sacrifice and killing of self - and indeed in many respects the killing of others is almost irrelevant – we are talking about martyrdom.

This man used concepts such as ‘evil' and the like, which are a long way from what psychiatrists can talk about. And he talked about the causes of suicide bombing as being poverty, illiteracy, and a hatred of democracy and the American way of life. But in fact all those three assertions, as the rest of the meeting made very clear are, in fact, largely untrue.

One thing we know about suicide bombers is that they're not from the poorer sections of the affected communities. On the contrary, most of them come from the middle or lower classes, in particular where we have the best data, Palestine; but also from other conflicts as well. They are most definitely not illiterate. On the contrary, they are often recently well educated, many of them were young students and again, illiteracy was not a factor; so much so that another expert at the meeting pointed out that one of the consequences of the current US Development Programmes - in for example, Pakistan, based on increasing literacy - is simply to increase the number of people able to read Al Qaeda web sites …

And the other thing that was made clear was that they didn't have what our White House person called a hatred of the American way of life; by which he meant democracy and so on. And again, what was clear for most of the participants of the meeting, on the contrary, for many of the people involved in suicide bombing, these were the same aspirations they had for themselves. They also wanted to partake in some form of democratic process but felt it had been denied them.

So what was the end conclusion of the workshop, as to what was the motivation behind suicide bombing? We were talking particularly about the Israel – Palestinian conflict but also moved on to others, as well, Chechnya and Sri Lanka; the Tamil Tigers figured quite heavily. The answer seemed to be unequivocally, it was a question of ideology; that fundamentally, the motivation, and the only real understanding they were able to put forward, came from an understanding of the ideological motivations of suicide bombers and their desire for martyrdom. In other words it was really not much to do with a psychiatrist, at all. The conclusion was that they were not mentally ill, and that this was an ideological conflict. Now, that's a kind of preamble, but it's important because it gives you one perspective I suspect, and an understanding of one part of the mess and the jigsaw that is contemporary Iraq – the phenomena of suicide bombing. But, is that in any way relevant to another question, which is - and again my main interest is the performance and health of the British Army - why does the British Army fight in the way it does? Why, also, does it stop fighting when it does? There's a big debate that goes on amongst people who think about these issues, particularly amongst historians, as to the conflicting roles of ideology and why soldiers do the things that they do.

best interests.

It's interesting to examine the different methods used by the British Army compared with the American Army and whether it's not by chance that in Falluja there has been so much violence compared with somewhere like Basra, where I know the conditions are very different? Whether the way the British have responded has done more to contain the violence as opposed to provoking it? I'll just make the points we've written very, very quickly. I have talked to various journalists, and I'd like to talk to more and hear more of what you say. When the British Army goes in, they realise from the beginning that they actually have to build up relationships in the community. If there is a bombing they go in and talk to the local leadership, the warlords and they get guidance, they get advice. They still have respect for recognising that the elders will have more understanding of how to manage the violence.

If you compare what the Americans have done in Falluja, they had the terrible humiliation of the four contractors being dragged through the streets. But what did they do? A military bombardment that killed 700 people; and what you see is the more moderate element then aligning themselves with the insurgents. How we need to win hearts and minds is very much influenced by the style in which we intervene.

Mark Brayne:

If any of you have read Chris Hedge's book, War is a Force that gives us Meaning, you will hear the echoes in what Simon was saying that war, however dreadful in many ways, can be quite fun. It's pretty boring to go back to look after the repairs to the fridge and things and journalists face that experience when they come back.

… I'm interested, Simon, how people fight for the group. But the sense of humiliation and deprivation of identity, as we know very well from the psychotherapeutic consulting room, is also central to the reason why some people act out or seek to impose their views violently on others. Let's put it out to the forum.

Barbara Probst:

I'm Barbara Probst and I'm a former BBC journalist, turned counsellor. I was curious, Simon, about you talking about suicide bombers fighting for ideology and martyrdom. I think Fanita English wrote a paper on The Lure of Fundamentalism , which actually looked far more at how the lack of structure also pushed towards that. I wonder if we don't pay enough attention to that? The fact that these groups are seeking their own structure, and have their own hierarchy with the pinnacle of that being the suicide bomber. And in that sense, the way that we view, the way we approach war, maybe it's the same thing in Iraq. Maybe the British are actually respecting the structures in Basra, going to the leadership rather than individual people. Perhaps we should look more at the structures as well as the people.

Nick Wrenn:

Nick Wrenn, CNN. Our correspondent Walt Rogers today said that he saw the video of the beheading of one of the hostages yesterday and said that's an image and an experience that will stay with him for the rest of his life. Now, this is a bloke who's been reporting from frontlines for about four decades now. We like to think that journalism as a profession is starting to face up to the realities of looking after people who go into the front line in terms of trauma. You referred to the military and so did you Mark, I'd just like to get a sense of how you think that the military is progressing with this, in terms of facing up to it as well?

Simon Wessely:

Okay, well the two responses are very, very different actually. The first point about structure. You're absolutely right that there's a lot of debate about the social structures of suicide bombing. And the one things from the psychiatric point of view that came over very strongly was that, as far as I know, there's never been an individual suicide bombing. These are not people who just get absolutely outraged by the Israelis and decide they're going to go and blow themselves up. It's a very, very complicated social activity for which people are groomed; that's the word in fact, that the Israelis use and it's probably quite a good one. It takes a long time to train a suicide bomber.

Again, even the language itself is perverse, but that's actually the language they use. It is, of course, the way in which the Israelis are, at the moment, defeating suicide bombing, by destroying the structure; and as a short-term tactic it is very successful. The Israeli General who's in charge of it and who was speaking at this conference said, ‘It's working'. That was his absolute phrase, he said, ‘it's working,' and someone said, ‘For how long?' and he said ‘I don't care.' He said, ‘I don't care, that's not my job.' That was exactly his response. He said, ‘I don't care.'

So yes, you're absolutely right. It's a socially structured activity in a very perverse and quite chilling way. That's what it is, and as a short-term tactic, attacking that social structure has been successful.

The second thing is completely different. We were talking about how the army's views towards trauma changed. But the army's views have both changed and not changed. In a sense, long years of observing them and how they deal with these things have led me to the view that the army – I mean all the armed forces - can be both extremely sensitive towards psychiatric breakdown and extremely insensitive. It's all a question of values. If they think you've earned your breakdown, as in the case of Simon Weston, the famous Falklands veteran (which is very public - he's had a series of psychiatric problems), no-one could be nicer to him than the rest of his military colleagues. He's invited to all the reunions and so on. Why? Because they feel that he has earned it.

On the other hand, if he'd broken down on the way to the Falklands, as many do, then the military can be less than compassionate. If they feel that you have not earned your breakdown, you may not get such a smooth reception within the armed forces. And before we actually condemn them for that, you have to remember that the armed forces exist for a particular purpose. It's a goal-directed activity towards fighting; it is not about emoting. They're very goal-directed, and in many respects they're rather good at it. So I've ceased to judge them on that, except to notice that they can be both condemning of psychiatric disorder and very, very supportive of it – it all depends as to whether it fits within their own moral codes.

Howard Tumber:

Howard Tumber from City University . Just your last bit about the way the army reacts. I was curious about what work you've done on the way soldiers operate together. You've said ‘ The army reacts'. Sometimes it's sympathetic if they feel somebody's earned it and sometimes they're not;. But what about the actual military men themselves? The reason I'm asking is because I'm more interested in the way journalists operate as a group together. When I did a study many years ago about the Falklands and interviewed all the journalists and camera crews and photographers, all the 20-odd people who went to the Falklands, there were one or two incidents where journalists did have psychological problems. In fact there was one young journalist who on the way down wasn't able to cope with it, and the journalists themselves helped this particular journalist. They actually wrote his copy for him in some of the instances because he wasn't experienced and he'd been put in a situation where he couldn't cope. Eventually he was sent back from Ascension, I think it was, on the way down.

So I'm just curious in a way about the way they operate as a group and what happens to some of the soldiers if they do experience psychological problems – not from the military authorities but from the group themselves?

Simon Wessely:

Well, again, our own studies and many others suggest much the same. The small group works much as the large group as well, because of course, whereas journalists and soldiers are quite similar – at least those who cover wars – they do like the excitement; you can't get round the buzz. Where it becomes different in the essence of military training is the subordination of yourself to the group. Ultimately successful armies are those in which people will finally, if necessary, sacrifice themselves to what the group is doing. Hence military medicine is extremely different to normal medicine because it's about keeping the mission going; it isn't necessarily about preserving lives.

Now, I'm on dangerous ground here but that's not my observation of journalists. On the whole, group identity is much looser than individual desires and it is quite possible that you will, if necessary, break away from the group in order to file a story. That behaviour is anathema to a military code, it really is, and that's partly a result of training and partly the result of culture.

So, going back to your first question. Soldiers who are showing psychological difficulties have problems within the small group because they start to be regarded as less than reliable. One of the big problems we have in trying to work out psychiatric policies is that the policy is to try and keep people in uniform and in their role for as long as possible so that they can come through it, whereas what the actual group wants is to get rid of them because they can't trust them any more.

So there's a big contradiction between what we want to do as psychiatrists and what the group themselves want to do -- which is usually to exclude people who are showing signs that they're going to crack up, because in the heat of the job that they do, they can't trust them. And I think there's quite a big difference there between – I'm aware you're grinning there and I might not get out of this alive but – that's where the dynamics of soldiers really are very different from the dynamics of journalists.

Mark Brayne:

Can I just pick up also on Nick's point about the witnessing of violent images? Gabrielle, you talked strongly about the imposition of violence - the effect that will have on the behaviour of people who are caught up in the drama and the dynamics of the violent situation. From your work with groups and individuals and psychotherapeutically, what can we learn from what's happening now and what can we bring to journalists to pick up on what Nick is saying, that some of our people who've been covering this kind of thing for a very long time are saying, ‘This is different; there's a new quality here that is really getting to me?'

Gabrielle Rifkind:

You mean by the level of bombardment of the images that people are being exposed to? And it's reaching the point where it's breaking a boundary about …

Nick Wrenn:

… as we get closer to the news story, because of technology and access etc., we're exposed as journalists in the field to ever increasing horrors.

Gabrielle Rifkind:

This is a theme that's running through, which I know as a group analyst. What people need around community and identity and belonging - and whether that's the structures for suicide bombing or something else - is that when they have had very, very difficult experiences, one thing that does make a difference is having a place to share it and having the kind of group supports that you can offer each other. Because it is quite easy to think, ‘What is the matter with me that I am so disturbed by this?'

Now it could be the kind of drinking that goes on in the bar amongst journalists, or more formal structures in which you actually mentor each other or offer real supports or really find out what's happening. I think there's a danger that those kinds of feelings go underground, because it's not seen to be macho and that you have to seen to be coping. It could be that you had some kind of pair, someone who was checking out how you were reacting or that you are put in real support systems. I think that is the thing that makes the difference, the actual healing component of what you can do for each other.

Paul Reynolds:

Paul Reynolds, BBC. I've covered a number of conflicts and my question to you is, if journalists like war so much, why worry about post traumatic stress?

Simon Wessely:

Well, you could say the same about soldiers of course - why do you worry about these things? First of all, post traumatic stress is quite rare within the military; much more common is depression and alcohol … Much, much greater changes happen in depression and drinking, which actually are much more of a mental health problem than PTSD within the military, and I suspect, within journalism as well. The question, why should you worry about it, well, why would anyone worry about any psychiatric disorder?

… remembering bad things, including the things you've talked about, is emphatically not a psychiatric disorder. The difference is, that what in fact people forget about PTSD is – they talk about the flashbacks and things like that – that it's also the disorder of functioning. It's that people can't actually do their lives. They can no longer be part of a family, they can no longer earn a living, in other words what the psychiatric disorder is, is the disorder of function. It's a mistake to think that it's a disorder of memory, because to have traumatic memories, when bad things have happened to you is not a psychiatric disorder. In fact, I'd go as far as to say that that is normal, and the abnormality is the one or two people that don't seem to have these memories. So [it's] a big distinction between memory and function.

Paul Reynolds:

Do journalistic organisations have the proper structures in place to train people for conflict and, as it were, debriefing?

Simon Wessely:

I'll just pick that one up. I don't know about journalist organisations but two things: first, you cannot train people not to break down in battle – I'm talking about the military now. The training that people give is in professional skills, and that's what the British Army is very good at. It's through the whole of military training not to break down in battle. But what you can't do is give ‘psychological training.' The idea that you give a psychological lecture to a bunch of the British Army would be laughable and it would also not work. So the best training is professional training through the skills, through leadership, through morale, equipment and so on.

And the second point you made is about debriefing, when people come back from trauma. I'll just make one observation. There is no doubt whatsoever that psychological debriefing after trauma does not work. So asking people when they come back to sit down and talk about it becomes a one-off, single session psychological debriefing; not only does it not work, nearly all the studies now show that it actually makes it worse.

Paul Reynolds:

But (British former hostage) Terry Waite said it was very helpful for him to talk.

Simon Wessely:

Well, unfortunately I only know what I read in the paper, I've not met him. He didn't have psychological debriefing, as far as I have read. He had an proper and prolonged course of psychotherapy, which is really rather different. I'm talking about single-session, psychological debriefing with people straight after they've been exposed to a trauma, whose only thing they have in common is that they were in the train together, or whatever, and where they're asked, ‘How was it for you? Talk about your feelings.' Emotional disclosure shortly after trauma is really not for debate. It doesn't work and most of the evidence suggests that it will make you worse. That is completely different from serious and prolonged psychotherapy. –That's a psychiatric treatment. That's not single-session debriefing. Gabrielle, you've got to disagree with me.

Gabrielle Rifkind:

Unfortunately I can't disagree with you because what would be the point in having a one-off session just to describe what happens to you? My answer is processing it and putting it back together in a different way, and that takes time and it takes a relationship.

Paul Reynolds:

The current journalistic organisation is based on simply talking to people when they come back, so what you're saying is that's completely useless, and in fact what Simon is saying is that it might even be counter-productive. What does Mark say about this?

Mark Brayne:

I think a certain amount of clarification is due here. For those who aren't across the complexities of the debate about psychological debriefing, critical incident stress debriefing and support for people who are being or have been exposed to trauma and traumatic experiences, what Simon is actually questioning - in fact stating – indeed does not work. And there are plenty of surveys to prove that this is at best neutral and at worst can do damage. In fact I've seen this personally as well, the one-off session where a counsellor comes in who nobody knows, gets a group of people together, they have a big ‘cathart', everybody cries and they go away and that's it. That is bad, it just makes things worse and it's irresponsible.

But let's look at the perspective. In the 1990s people suddenly thought, ‘Oh, my God! There's a problem - trauma, help! We need to do something.' The thing that they've been doing for the past 10 years is perhaps not the best thing to be doing. But that's not an argument to say we don't do anything at all. The argument that we work on with Dart, and I think the Royal Marines do this very successfully, is one of solid systems of good management, good team relationships, support, collegial support, group work, in the sense of a healthy group that's supporting each other. So people feel supported by management, and don't feel betrayed, humiliated, let down.

Betrayal after Vietnam was one of the main issues around PTSD - that people felt let down by the military commanders. There is a model of preparation for trauma and response to trauma afterwards that's very sensible and grounded. It works in the marines and several of us believe that this will work very well for journalists. It's not about single-session debriefing afterwards, nor is it about simply bottling stuff up and pretending that everything's okay when sometimes it generally isn't, as Nick said about one of his colleagues. It's good to talk about the experiences that people are having after they're watching really violent images, not just to bottle that up.

Babak Behnam:

Hi, I'm Babak Behnam from NBC News. Can you walk us through the minds of these people that are doing the beheadings and describe how different they are from suicide bombers?

Simon Wessely:

I don't know what Gabrielle can do but I genuinely have absolutely no idea.

Gabrielle Rifkind:

I suspect that we all have ideas but I'm not sure that we do really know. You do have to live in a state of disassociation to do it. You cannot think about what you are doing. You have to somehow convince yourself of the ideology or the political objective of what you're trying to achieve, and we can convince ourselves of anything should we wish to. Plus with the power of the group behind us to do it. Disassociated states tend to be more psychotic states but I'm not sure whether we could make those kinds of correlations.

Simon Wessely:

Beheadings are not new. There are many examples in the history of warfare and counter-insurgency going back to the Malayan emergency, going back to the Pacific war, let alone the various wars of the Russian States where symbolic beheading of hostages or prisoners has been used; so it's not new. It may be more televised but even then, there were many pictures from the Second World War in wide circulation among American troops of famous pictures of both Americans and Australians being beheaded – that were encouraged to be in circulation because they did increase the ferocity and hatred of what was an ideological war by the Americans and Australians. I don't actually think it's particularly new; to be honest.

Even the publicity I suspect, isn't new. There's a Life magazine in 1942, I think it was, that had a picture of an Australian flyer being beheaded that was passed by the censors precisely because it would increase hatred and aggression, as it almost certainly did. So I don't think it's a new departure but apart from saying that, whoever did this are not mentally ill. I don't think to use psychiatric explanations is going to be at all helpful. If ever these people are apprehended, they will not be mentally ill, as a psychiatrist would describe it. That I'm sure about.

Gabrielle Rifkind:

I agree with that. I think it links with the political objectives that in fact, if you stir up enough hatred, you get retaliation and then in that process, when retaliation comes, you get more people to sign up for your cause. So it's also very strategic.

Simon Wessely:

I think there's a religious symbolism to it. I'm sure there are people who know that much better than me but I understand it has some religious symbolism to do with the slaughter of animals, doesn't it?

Babak Behnam:

The fact that you've cut another human's neck, I mean, these people just can't walk down the street and say everything's okay, afterwards, can they?

Simon Wessely :

I've never met anyone who's done it, to be honest, so about the only thing I can say as a psychiatrist is that I have interviewed quite a few multiple murderers in the old days when I was doing forensic psychiatry. And the only thing I remember them saying which is at all relevant is that they did say, ‘It gets easier.' That's the only thing I do remember was one of them saying, ‘Actually, it's not as hard as you think,' and he did say, ‘It gets easier,' I remember that.

Joan Bird:

I was a journalist for many years and now am a consultant and an NLP practitioner and I just wanted to add a different dimension to this discussion. NLP, for people who don't know what it is, is the study of how experience affects behaviour. One of the pre-suppositions of NLP, interestingly, is that even the most inappropriate behaviour has a positive intention behind it. So even your beheader or your suicide bomber will have a positive intention for that. People aren't innately evil but they always have a positive behind whatever they perpetrate.

One of the questions that I'd like to ask is how we can deepen the understanding and learning of our journalists so that they do have an understanding of what goes on in these situations. I personally would love all journalists to go on some kind of course that would give them an insight into these psychological situations.

So one of the questions I want to ask tonight is how we can support journalists in dealing with this kind of thing. Talking about your correspondent in Baghdad who is really badly affected by this latest beheading, it's something, again, that we should be looking at very closely and saying, ‘How can we give support to these people? What can we do before journalists go out to places like Baghdad, to give them the resources to deal with these things as and when they happen?' It's not happening at the moment, as far as I can see. Safety Training is all well and good but what about the mind? What about the safety of the mind? I really think that needs to be looked at quite seriously …

Mark Brayne:

Helen Law, can I bring you in? You help run and are one of the job share leaders of BBC journalism training. How do you see the implications of the questions Joan raised there, preparing people before they go? Also, for the kind of journalism that gets practised and the preparation of the journalist to be able to cope better both professionally and personally and in all sorts of ways rather than just responding after the event?

Helen Law:

I think we're beginning, working with Mark and others to look at what training we should be doing, so that it's not just about skills and knowledge and editorial but it is about seeing things more generally. I don't know how much you can pre-plan for things but you can definitely open people's minds, perhaps, to things they haven't thought of before. We're looking at how we should do that, both in this country and overseas.

Mark Brayne:

Nick, can you say something about CNN and the implications of this agenda because Joan's raised a lot of questions.

Nick Wrenn:

I just think it's safe to say that probably CNN, in common with many other media organisations, is taking the issue of support and as has been said, team work and a management structure, very seriously these days. It's integral to how we decide who goes in the field and when and for how long and how we manage them when they come back and I think it's work in progress …

Simon Wessely:

… There's a thing called battlefield tourism that many of those who went on the road to Basra did, and they just showed these like they'd show you pictures of their girlfriend and they also showed other photographs. So simply seeing bad things - that I would see as bad things - I found it very hard to notice that this had any particular psychological impact. So again, it comes back to what I finally concluded that was, we should beware of any generalisations as we talk about these things.

And what I've been talking about was the particular circumstances of the groups that we study intensively, which is the British Army. It's different from the American Army and again, one final point to pick up on, I actually think that the whole reason for the differences between what's going on between the British and the Americans, is all down to sunglasses. I should think the root of the problem is sunglasses. I don't know if you've noticed but you don't see pictures of British soldiers wearing sunglasses? They're not allowed to when they're actually on duty whilst the Americans do,. I actually think that that explains everything; the difference between British and American doctrine – it's all down to the sunglasses.

I wasn't being facetious. If you're in a peacekeeping situation and you actually want to tone things down, it's quite important that you make eye contact with people. In the same way, the British Army in Iraq are not using women in frontline roles and the Americans are; it's quite difficult to control that kind of crowd in that kind of place using women soldiers It's not a moral thing it's just a statement of fact, it's the way Iraqi culture works, it's hard to do. It's hard to do when you can't make eye contact. Sunglasses are dehumanising and British doctrine is, you don't wear them; and it is one reason why the Army doesn't use women in combat roles.

Gabrielle Rifkind:

It's interesting your point on women but I would think it's possibly for different reasons. For the Iraqis it would not be respecting their culture to have women in that public position. In fact women could defuse conflict and maybe would be more likely to talk people down without using physical force. But it's more about being attuned to what's acceptable in a particular culture.

Andrew Kinder:

Andrew Kinder, Chair of the Association for Counselling at Work and a psychologist. I was particularly interested, Simon, in some of your comments about debriefing which I think is a valid point about the inadequate research that has been done on debriefing – some of it is yours, yes. A couple of points: one is that why does the media pick up debriefing and potentially throw out the baby with the bath water? What is it about the media that wants to chuck out something that can help some people? I'm not particularly in favour of the one-off session debrief but the one where you identify people who are suffering and you then provide follow-on support, I think that's the one that many organisations I'm aware of, actually do provide.

Simon Wessely:

Again, what you're really saying is not so much why the media pick it up but why do we pick it up? Debriefing makes us feel better. When we see a disaster with the blue light still flashing and we hear that trained counsellors have been sent, it makes us feel better. It makes us feel that something is being done. It's a mark of the severity of the disaster; it's part of the symbolism and the theatre of it and it's also because we don't like seeing people in distress. We think a terrible thing has happened but so long as the counsellors get there, we will be spared the sight of people in anguish. That's why we do it.

Why doesn't it work? It's because, well we've already touched on it; it's too early for some people, for some people talking isn't necessarily the best thing, some people have different emotional reactions; and most importantly of all, when people really do wish to talk at a time and a place of their choosing, they tend to talk within their own social networks to people they know before and people they know after – their family, their GP, a priest, whatever and that increases social support and mobilises social support and increases their social network. Talking to the one-off professional who they've never met before and will never meet again, all our research suggests decreases social networks and actually impedes the normal process of social support.

That's why it doesn't work. Why we like it is not because it makes the people in disasters feel better, because when a bad thing happens you feel bad, and that's just the way it is. It's because it makes us feel better. And finally, I'm a psychiatrist, I'm trained in CBT, that's what we do. But that's treating a small number of people who have developed psychiatric disorder where the evidence is overwhelming that psychological treatments work. It's not a one-off thing and it isn't treating a large number of people who are simply distressed and who will get better.

Paul Reynolds:

If you're going to set up structures to train people in advance should you exclude certain people from going to these situations?

Gabrielle Rifkind:

Are you now referring to journalists or whether there should be some kind of screening as to suitability? It seems a very important question because if you look at people who become traumatised – one has to be very careful how to say this – but people can have certain propensities; it's not by chance when you give the example of the soldiers who break down before they fight, you'll probably find an earlier trauma already in their history. The fact that people often re-traumatise means it would be the most generous thing in the first place to have some sense of peoples' robustness to certain conditions. You're actually doing people a favour by doing that.

Simon Wessely:

I have to say I don't agree with that particular view, only because of the practicalities. If you take the things you were screened for, let's say the risk factor to break down - going back to the military situation there are things like coming from a single parent family, having a poor school record – these are the things you'd screen for because they're measurable, in order to screen they've got to be measurable. That's how you do a screen programme, that's how militaries have done it in the past. You take all these factors, all of which predict breakdown in battle – they do; they're weak predictors. Now, if you excluded people with all those risk factors you would remove a large chunk of the British Army.. They're weak predictors and the very best set of risk factors that you could use; you would still be rejecting several people for every person who you would have protected from breakdown. And you've also got to think about the many people who you have said cannot go on deployment or cannot go to Iraq etc, because they're psychologically vulnerable, who would in fact not break down, against the one who would and those other people have been seriously disadvantaged. Whenever this has been tried, because it's been tried many, many times, it's always failed because of the problems of prediction; that individual predictions are too inaccurate to be useful to be able to say Private Jones or Mr So and So, if sent into trouble, will break down. Our predictions are not that good.

Gabrielle Rifkind:

I would say I'm not surprised they're not that good because I don't think you can take those kinds of criterion, it's much more complex. You cannot look for those kinds of predictors; you can come from a two-parent family and be at risk; it's irrelevant. What actually matters is earlier experiences around trauma and what you've made of that. In fact, you could maybe better prepare people; if people knew their own histories they might know what their vulnerabilities are and what they will or won't be susceptible to. So I think it's much more complex and it's much more done relationally as opposed to looking for indicators.

Mark Brayne:

We need to wrap up. Just a brief comment from Ruth Ludgate and Sarah Ward-Lilley.

Ruth Ludgate:

Ruth Ludgate, Counsellor. I've several very quick points. Apropos this business of selection, it's not only trauma in childhood, it's literally where a button has been pressed. Going back to the Soham murders, how awful it was for the journalists who had their own families. A second point is I think there would have to be a huge change of culture within management because of this sitting there back at base saying, ‘We want this and we want the thing.' And the third thing I think must be particularly difficult for journalists is that, a policeman of Soham talked about the fact that it's not the people at the centre of the drama who necessarily suffer from PTSD; like at the Kings Cross train crash, it was people like the parking policeman outside, or something. It's a sense of helplessness and I think journalists in a war zone are suffering from a very difficult conflict because they're both helpless and powerless and have power in relation to the media and I think that sets up something that hasn't even been looked at yet.

Back to the beheaders; what more power can you have than being able to cut off somebody's head?

Sarah Ward-Lilley:

Mine's just a very small point on the screening. I think if there were a way, and our conversation has proved there isn't a way of doing it effectively, it would be wonderful. But there obviously isn't and I think it's a much more subtle and complicated approach, which is about us working as Helen Law was saying, to prepare people as best we can to think about what they might be facing and therefore be ready to self-select themselves out. Also to change the culture, certainly in the BBC and I'm sure it's the same in other organisations, that it's okay not to want to go and that you're not only going to be able to progress your career by going. And if you take that out, which is going to take a heck of a long time, and you get them to think about whether they themselves, whatever may be going on in their heads and in their history – which you don't, as managers need to know or want to know and they won't necessarily tell you but - at least they've had a think about it before they go; that's the only kind of way you can do the selection.

Mark Brayne:

Thanks. It is time, as one says in the profession. There are a lot of things that could be said but extremely briefly, in one sentence, to wrap up?

Gabrielle Rifkind:

I'd like journalists to think more around the relationship between trauma and how decisions are made at the highest political levels; because I think it's something we don't know much about but I think is maybe an important area for us to open up.

Mark Brayne:

Thank you very much indeed. Thanks everybody for coming. Conversations like this are still so difficult to nail down. There's so much that hasn't really been discussed, hasn't become part of The Story, which everybody understands what it is. We're identifying aspects of the journalistic experience and the reporting of conflicts like Iraq – we're identifying things that haven't yet been discussed so if some of you feel that perhaps we've ranged rather wide and raised a lot of different issues - it's probably because we've ranged rather wide and raised a lot of different issues … But I hope this has been a useful contribution to identifying what it is that we need to focus down on and take forward, which is what the Dart Centre Europe for Journalism and Trauma is all about. Thank you for your support and please keep coming and keep talking.