Professor on the frontline in fight to explain our casualties of war

IT'S always fascinating, asking doctors about why, with so many disciplines to choose from, they selected their particular field and whether each discipline creates its own stereotype.

Simon Wessely says he got "the Dr Kildare stuff" out of his system early on in his medical training and, because he had been taught psychiatry inspiringly at Oxford, began looking seriously at the subject quite early on. "I found some other areas, like surgery, a bit less thoughtful, and psychiatrists were the kind of people who were interesting to sit next to on a train."

He was also influenced to some degree by the work of the late Prof Anthony Clare, who increased popular understanding of the science through his penetrating BBC Radio 4 programme In the Psychiatrist's Chair.

Nearly 30 years into his career, with many different jobs, books and around 500 published academic papers behind him, the direction of Prof Wessely's work has increasingly moved towards the field of illnesses with unexplained symptoms, such as Chronic Fatigue Syndrome (or ME), and the occupational exposures and health of armed forces.

Based for many years at the Institute of Psychiatry, King's College London, he is an internationally renowned expert and Government adviser on Gulf War illnesses, more commonly called Gulf War Syndrome (GWS). He's also director of the King's Centre for Military Health Research, and his team's work has directly influenced policy regarding the health of British armed forces.

"I've never made a secret of the fact that I greatly admire our armed services and feel we don't value them enough. Those feelings have no doubt been influenced by my father's background." As a teenager his dad travelled alone on the Kindertransport from Prague to Britain to escape the Nazis. He was fostered then adopted by a family in Cottingham, near Hull and went on to serve in the Royal Navy before becoming a teacher.

Prof Wessely and colleagues opened the first solely NHS clinic dealing with Chronic Fatigue Syndrome back in the early 1990s. Not long afterwards, he began to notice reports of a growing number of soldiers and others who had served in the Gulf War suffering from illnesses with the same kind of symptoms as many of the CFS patients. The symptoms were wide-ranging but included bone and joint pains, listlessness, depression, poor concentration and rashes.

"No-one could fathom what was wrong," says Prof Wessely, who's in Yorkshire to give a lecture to the Leeds Institute of Health Sciences at Leeds University when we meet.

"There was increasing media clamour, but no-one was doing anything much about it apart from individual doctors studying individual patients. What was needed was a population study – research comparing a large group of armed services personnel who'd served in the Gulf with personnel who'd served somewhere else. The second group we chose had served in a peace-keeping role in Bosnia from 1992 onwards."

For several years, funding couldn't be found for the study, but the Pentagon finally came forward. "The Americans are, in general, quicker off the mark and more attuned to the problems of military veterans. It's a bigger political issue over there. The Government also has to take better care of veterans because they

don't have a universal healthcare system like ours."

Wessely's research revealed that something was definitely going on among the British patients that was linked to having served in the Gulf, but he (and now other experts) agree that while all of the illnesses were real, no unique collection of symptoms that could be called a "syndrome" was identifiable.

The study also concluded that serving in the Gulf had worsened the general health of military personnel, although it had not increased the incidence of cancer. The death rate amongst forces serving in the Gulf was the same as those who had served in Bosnia.

There were three obvious potential "villains" that could have been responsible for the illnesses. Wessely says research revealed that the symptoms were not caused by the depleted uranium or pesticides the military had been exposed to, but there was an apparent link to inoculations given against the effects of biological or chemical warfare.

"Those who were sickest appeared to be more likely to have had the anthrax vaccine, but this was contentious and inconclusive because of a lack of records kept by the military. To this day the issue is inconclusive, because records were not kept and the right studies were not done early on.

"We've been successful in saying what didn't cause Gulf War illnesses, but no-one has been able to point definitively to what did, and the focus is now shifting towards what we can do to help those who continue to suffer. I'm somewhat pessimistic that we will ever unravel the causes of GWS."

It's thought that around 20 per cent of those who served in the Gulf suffered illness to a greater or lesser degree. Those with GWS are entitled to a war pension ("and quite right, too" says Wessely), but veterans' groups would like the Government to take responsibility and pay compensation.

Research on the health of military personnel involved in the Gulf War provided valuable pointers as to how to do things better in subsequent conflicts, says the professor. "In 2003 came the invasion of Iraq and this time lessons had been learned about how health surveillance of the armed forces had been badly managed in the previous Gulf War.

"This time the forces carried out health surveillance from day one, so that if anything was spotted going wrong they could try and sort it out there and then."

Depleted uranium, pesticides and anthrax vaccine are still used in theatres of war. Wessely and colleagues have randomly selected a group of 8,000 from British forces involved in the recent Iraq War and collected health data to follow their physical and psychological health. They're looking at everything, including the incidence of mysterious multi-symptom conditions, and comparing the data to a group of military personnel who have not served in Iraq.

The research has been funded by the Government but is, Wessely insists, completely independent of the Ministry of Defence.

"We'll publish everything we find, even the stuff they'll find embarrassing." The study is ongoing, but a major report based on the research is due to be published later this year, with "data so far showing no new 'Iraq War Syndrome'."

Although Iraq veterans' mental health was shown to be "surprisingly good," reservists had experienced increased incidence of mental health problems compared to regulars. This is linked, says Wessely, to a less satisfying experience of how they are deployed, how long they serve and the kind of help they are offered on their return from war.

Previously they were not offered dedicated and specialist military mental health services, but since the research they are now deployed differently and offered the same health services as regular forces on their return.

Prof Wessely has also been involved in recent moves to train military personnel in peer support, as a way of lessening the number of mental health problems.

Most sergeant majors in the Royal Marines have now had mental health awareness courses, or "trauma management".

"Soldiers are very macho, it's part of their resilience, but the strength that makes them a good soldier can make them a bad patient.

"Talking to another soldier about problems is therefore easier than being sent to a psychiatrist, and the message is that it's okay to ask for and get help. It keeps it in the family. The quality of care given to physical casualties in the theatre of war is far better than in the NHS, and second to none. I've seen it.

"The same can't be said of mental health problems, but the level is improving. As with mental health in general, historically these things have been swept under the carpet, and failure to come forward is still a problem – for all of us, not just the military."

Prof Wessely is disliked by some CFS sufferers and support groups. "People want biological explanations and treatments, but we have definitely shown the importance of psychological factors," he says. "The people who don't like me are not the thousands of people I have treated over the years. The opinion I care about most comes from my patients and my peers."

"Expectations of health are now much higher than ever before. We don't have the kind of major worries previous generations suffered, like the possibility of dying of respiratory disease at 33, losing a limb while working in a mill or bombs being dropped on us by the Luftwaffe. We have different things to worry about, and expect a life more or less free from either physical or mental illness. But when we are ill, we're generally more aware and willing to admit to symptoms."

Except, it seems, where mental health is concerned.


Prof Simon Wessely MA, BM BCh, MSc, MD, FRCP, FRCPsych, F Med Sci (degrees include a masters in History of Art)

Age: 52

Born: Nether Edge, Sheffield

Education: King Edward VII School, Sheffield; Cambridge, Oxford and The London School of Hygiene

Current employment: Director, King's Centre for Military Health Research, Institute of Psychiatry (IoP), King's College, London; Professor of Epidemiological and Liaison Psychiatry and Head of the Department of Psychological Medicine and also Honorary Consultant Psychiatrist at the King's and Maudsley Hospitals; Honorary Civilian Consultant Advisor in psychiatry for the British Army; trustee of the charity Combat Stress

Family: His wife Clare is a London GP, two teenage sons

Hobbies: Skiing, cycling (recently did a London-Paris fundraiser in aid of the Royal British Legion), art, history.