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Book Reviews Review: John Conrad’s Among the Walking Wounded and Adam Montgomery’s The Invisible Injured explore PTSD in Canadian soldiers

Canadian soldiers take aim at a target in the village of Kairo Kala west of Kandahar City, Afghanistan, during a patrol on April 18, 2010.

Louie Palu/The Canadian Press Images

Among the Walking Wounded: Soldiers, Survival, and PTSD

By Colonel John Conrad

Dundurn, 232 pages, $24.99

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The Invisible Injured: Psychological Trauma in the Canadian Military from the First World War to Afghanistan

By Adam Montgomery

McGill-Queen's University Press, 331 pages, $34.95

Barry Westholm didn't know what was wrong with him. He couldn't focus, he couldn't remember things, he couldn't sleep. He was frequently anxious. Medical tests revealed no physical ailments, so as a coping mechanism, Westholm completely devoted himself to his work. He "soldiered on," as the saying goes – a fitting mantra for Westholm's vocation as a military vehicle technician.

It was 2007 before Westholm finally got a diagnosis for his continued psychological difficulties: post-traumatic stress disorder. The event that had triggered Westholm's PTSD was a confrontation with a very angry mob during one of Westholm's deployments. During the incident, Westholm had considered shooting himself with his sidearm rather than being hacked or burned to death. Fortunately, before things degraded to that point, reinforcements arrived, dispersed the mob and evacuated Westholm. The nightmares started soon after.

This wasn't Afghanistan. It was Haiti, mid-nineties, and Westholm was deployed there as part of a United Nations multinational stabilization operation. This vignette is the first of many in Adam Montgomery's The Invisible Injured, and traces the crucial (and in many cases incomplete) development of mental-health awareness in the Canadian Armed Forces.

In recent years, mental health has become a prominent topic of public conversation. Various observances occur nationally and internationally – there are designated mental-health days, weeks, even months. One of the biggest objectives of mental-health education is the elimination of long-standing stigma associated with a wide range of conditions. In general, we can all speak openly about cancer and diabetes, but it's taken a lot of work (with more work ahead of us) to address depression and anxiety and even more severe afflictions.

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As civilian society adjusts more widely to mental health, our military is taking measures to keep up. There's an urgency associated with this evolution – for the 10-year span of Canada's involvement in Afghanistan, more than 40,000 service personnel deployed there at one time or another. Although our commitment to Afghanistan has ended, operations in Iraq, Africa and Eastern Europe are now under way (just as we had personnel committed to Haiti, the Balkans, Rwanda and many other places in the nineties), signifying that Canadian missions overseas are not going to cease any time soon.

These continued deployments make it necessary to ensure the military's mental-health support networks are firmly in place, especially considering the broader public conversation. It's also necessary for the Canadian public to have a better grasp of the current understanding of military mental health, as well as those attendant support networks.

At present, much of what people "know" about military mental health is what's depicted in the headlines, which might lead people to believe that most veterans are fragile, ticking time bombs, one loud noise away from some complete nervous breakdown. For the most part, this isn't the case – but there are certain risks and challenges unique to military mental health, just as there are both opportunities and critical shortfalls in the military's support networks.

Among the Walking Wounded by Colonel John Conrad and the aforementioned The Invisible Injured are two recent books that offer a much deeper glimpse into military mental health than what you might find in the headlines.

Conrad certainly has the bona fides to talk about the subject. His more-than-30-year military career has included service in both the regular and reserve forces. He was the chief Canadian logistics officer in Afghanistan in 2006 – a period that saw a significant increase in Taliban activity. By this point, the Canadian public had more or less accepted the Afghan mission as a war, even while senior staff and bureaucrats in Ottawa continued to cling to milder-sounding euphemisms.

Among the Walking Wounded is Conrad's second book about Afghanistan (his first, What the Thunder Said, was published in 2009, and described in great detail ammunition shortages and other logistic problems the Canadian task force encountered during Conrad's command overseas). Among the Walking Wounded is told as an extremely intimate memoir, not just of Conrad's deployment, but of the personal difficulties he experienced after he returned home. These difficulties included his relationship with his peers, his career as a regular force officer and ultimately his acknowledgment of his own compromised mental health.

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For me, the most striking incident in Conrad's book is not the combat deaths of soldiers in Kandahar (which Conrad relates with uncompromising clarity), but the lonely suicide of a two-time Afghan veteran reservist under Conrad's command back in Canada. This is an example of what can happen when a soldier either falls away from or is dropped by the support systems in place. It's even easier for a reservist – the vast majority of whom are part-timers – to be overlooked.

It's worth noting that there were attempts made to help this soldier, as Conrad describes. There were the mandatory check-ups all personnel go through coming out of Afghanistan, which take place at semi-regular intervals over the months following. There were also concerned friends, fellow reserve soldiers, who looked in on him. In other words, the are-you-okay-do-you-need-help questions were asked. Ultimately, these gestures were to no avail, and left the soldier's friends (including Conrad as commanding officer) blaming themselves.

The soldier's suicide was further complicated by the confusing, inadvertently callous way his family was treated after the fact. As Conrad notes, existing next-of-kin notification and support procedures were designed in an older time, when the nuclear family was still largely the norm. These days, with split families (which applied to this soldier's parents), the procedures are outdated, not easily applicable. The result, in this soldier's case, was a dad who was almost completely cut out of the notification, visitation and continuing support processes.

Conrad tried to intervene on the father's behalf, with almost disastrous consequences for his own already tenuous career.

Among the Walking Wounded is dense with military language and acronyms that would likely be opaque to the civilian reader, although Conrad does include some explanations where the tight pace of the narrative permits. There is also the interplay of rank – especially at the senior-officer level (real people in Conrad's book, including lieutenant-colonels, colonels and general staff) – which again would be difficult to understand by someone not intimately familiar with the way the hierarchy operates. This isn't necessarily a shortcoming, but it does position Among the Walking Wounded as a very personal, particular snapshot of a very particular time and place.

By contrast, Montgomery's The Invisible Injured takes a historiographical approach to the subject of mental health in the Canadian military. Indeed, The Invisible Injured is published by McGill-Queen's University Press, and is dense with scholarly research and an academic tone. Throughout the book, Montgomery takes us through trauma and treatment from the First and Second World Wars, peacekeeping in the postwar period, the American experience in Vietnam and, most recently, Canadian experiences in Afghanistan. He follows the understanding and diagnosis of mental injuries, from shell shock (First World War) to battle fatigue (Second World War) to PTSD (the contemporary terminology, likely most familiar to the majority of present-day readers).

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Montgomery carefully illustrates how the Canadian public's perception of the military (and, to a certain degree, the public's perception of itself, or of our national identity) evolved in a kind of lockstep with what our troops were doing overseas at a given time, and what kind of burdens they were coming home with. The most telling example of this, as Montgomery points out, is the image of the peacekeeper wearing the blue beret, an icon long-ingrained in our collective consciousness.

"Unfortunately," Montgomery writes, "just as peacekeeping became a national symbol, peacekeeping itself morphed into a vague and often euphemistic concept." He points out the usage of peacekeepers in complex ethnic and nationalist conflicts and civil wars, often with no clear direction or rules of engagement.

Although Rwanda and Somalia stand out in particular infamy for Canada, as Montgomery demonstrates, the war in the former Yugoslavia starkly revealed the shortfalls of mental health for military personnel. Soldiers coming home resulted in heavy drinking, domestic violence and, in some cases, suicide while the higher links in the chain of command put up a "wall of silence" against growing rumours (not to mention reports in the media) of psychological trauma.

Montgomery goes on to trace reformist steps taken in the early 2000s, starting with the military's establishment of the Operational Stress Injury Social Support program, as well as growing efforts to inculcate in personnel at all levels a belief that mental wounds could be just as legitimate as physical wounds. Montgomery concludes by looking at a continuing process of two-steps-forward-one-step-back in the process of putting better support networks in place, and – perhaps more crucially – eliminating the stigma surrounding mental health in the military.

Among the Walking Wounded and The Invisible Injured are both incisive looks at a thorny, frequently misunderstood topic. In many ways, they are complementary texts: Conrad gives us the deeply personal, while Montgomery gives us the scholarly and academic (although, to be sure, elements of either approach are used in both books). In any case, these are the kinds of books we need to read to get a better sense of what military personnel go through both at home and abroad, both in and out of combat.

If we are to continue to put people in harm's way to achieve strategic goals, as Montgomery suggests, we must move beyond our penchant for "politicking and myth-making" and have a full appreciation of what's at stake. Military personnel are not ticking time bombs. In most cases they are ready, willing and more than able to do the difficult jobs asked of them – but they deserve the right tools, the right support and the right understanding.

Matt Lennox is the deputy commanding officer of the Queen's York Rangers, a Toronto-based Army Reserve unit. He served in Afghanistan from 2008 to 2009. He is also the author of the novels The Carpenter and Knucklehead.

Editor’s note: In a previous version of this story, Barry Westholm was incorrectly identified as Barry Westholme.
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