The Lockerbie Air Disaster and the Gulf War: Debriefing in Britain
By Gordon Turnbull
NCP Clinical Quarterly 3(1): Winter, 1993
It all started for me on the morning of the 23rd. December 1988 when an urgent telephone call came through to the Psychiatric Centre at the Princess Alexandra Hospital, Royal Air Force Wroughton from the leader of the RAF Mountain Rescue Teams involved in the clearing-up operation in the immediate aftermath of the Lockerbie Air Disaster. Pan Am Flight 103 had crashed in flames on the small Scottish town of Lockerbie on 21st. December and all of the 270 people on board were killed. The aircraft had exploded 38 minutes after leaving Heathrow for New York when the aircraft was at 31,000 feet over the town. Eleven Lockerbie inhabitants were also killed. I had been in the past the "doc" to the RAF Mountain Rescue Team in Cyprus while drafted out there and knew the individual who had made this totally unprecedented request for psychological support by reputation to be the typically tough and hardened type one would expect. Therefore, the question of whether or not to respond positively did not arise; and the question became one of when to.
It seems important to make the point that the suspicion that the disaster was the result of terrorist attack loomed very large and the military units throughout the United Kingdom felt vulnerable universally at this time. This suspicion was later proved to be justified.
With great rapidity the first Royal Air Force Psychiatric Rapid Response Team was thrown together incorporating as wide a range of skills as possible. At this time I drew heavily upon the experience of my psychiatric colleague in the Royal Navy Medical Branch, Surgeon-Commander Morgan O'Connell, who had participated directly in the British military operations in the Falklands War of 1982. It was he who had noticed the large number of psychiatric and psychosocial problems which came to light after this campaign which had a direct relationship to involvement in the conflict. He had developed a group-orientated treatment method which had been successful in resolving many of these complex problems.
The team of five individuals which travelled to the home-stations of the Lockerbie Rescue Teams still harboured reservations about the wisdom of "interfering" in their self-therapeutic rituals, which were somewhat legendary. "Brainstorming" led to rudimentary concepts of how to carry out the debriefings. A great spur to increased endeavour was the immediate realisation on visiting the first team which had been directly involved at Lockerbie from the very beginning was that they had most definitely been traumatised by their exposure to the disaster and were most definitely in need of help. We rapidly learnt the cardinal rule in debriefing that it was not adviseable to enquire about the emotional reactions of such "exposure-hardened" individuals to begin with. Far better (and easier) to collect together the overall experience of the group and to lead into these reactions. The correction of individual misinterpretations and misconceptions using this technique was very impressive and made us very aware of the seminal work in this area by Marshall During World War II. By a process of evolution our team became aware of the intricacies of a good and successful debriefing. One concept stood proud of all others and that was "SANCTION". One had to have permission at all levels of authority to proceed. Although the directly traumatised had requested the debriefing, it was extremely important to understand that not everyone believed that mental health professions had a role to play in the treatment of acute post-traumatic stress.
This proved to be an opportunity also to "check-out" the concepts of PTSD. Certainly the members of the team were convinced of the validity of the operational definition of the syndrome of Post-Traumatic Stress. The vicitims (secondary at that) demonstrated the intrusive recollections, the avoidance phenomena and the hyperarousal said to be characteristic of the stereotyped reaction. Also, the debriefing seemed to help those afflicted. The problem of research to prove this point became a real difficulty. It was felt that it was not possible to both conduct befriefings and be involved in research. It was held strongly that the debriefers needed debriefing in turn.
The profound experience of Lockerbie led to a more intensive "look" at the Far-Eastern Prosoners-of War who regularly came to the hospital for medical assessment. Also, victims of individual rather than mass traumas were more closely inspected and more cases of PTSD were identified amongst those victims of road-traffic accidents and other personal traumas were discovered than was previously the case among RAF personnel and their dependents. Individual treatments evolved.
The Royal Air Force Medical Branch decided to introduce a system of "travelling fellowships" in 1990 and I was very fortunate to make a successful bid for one of the first. This also reflected the growing awareness of chronic stress reactions and their appearance in most of the specialty out-patient departments across the whole range. I travelled to the National Center for PTSD, Clinical Laboratory and Education Division, in Palo Alto, California and for two months was able to steep myself in the theory behind and treatment of traumatic stress reactions. The legendary American hospitality proved to be the case and I was introduced to a very impressive set-up where it was obvious that the staff enjoyed their difficult work, were actively developing their understanding of stress reactions, and that the clients seemed to benefit from their endeavours. In fact, so impressed was I by the therapy programme that I introduced some ideas into the structured ward-programme at my own Psychiatric Centre in Britain. For example, daily seminar-groups on subjects such as Anger-Management, Family Relationships etc.
The two-month sabbatical happened after the Iraqi invasion of Kuwait and the momentum of the crisis rolled on. As it turned out, the time spent in Palo Alto proved to be an "apprenticeship" for the time ahead - and not too far ahead either as I found myself perched on the very edge of the Middle-East (In Cyprus) within 5 days of touching down again on a cold and wet version of "England's green and pleasant land" when the time in California was, sadly, over.
The prospect looked very grim indeed and I returned to the UK to help to set up a Combat Stress Unit at Wroughton. Again it was useful to draw upon the experiences at Palo Alto. I was subsequently deployed into the field to Saudi Arabia and, fortunately, very few battle-casualties did come through our unit. There was a need to identify traumatic stress victims quickly and accurately and a need to intoduce them to a therapy programme that was short enough to permit the rapid passage of potentially large numbers of casualties through the system. We devised a battery of psychological tests which incorporated the standard British questionnaires, some innovated combat-related instruments and the CAPS-1 (Clinician Administered PTSD Scale). This last has come to have a very high reputation in the type of work undertaken as a very reliable and sensitive instrument.
The end of the Gulf War saw definite evidence that the subject of traumatic stress reactions had assumed a much higher profile in the minds of the military leaders as, for the first time in British military history, there came a request for the British ex-prisoners-of-war to be debriefed prior to their return home. This work was undertaken in Cyprus and lasted a week. This was an opportunity to try out at first hand the principles of critical-incident debriefing which had matured since the Lockerbie incident. It seemed to work well. Sanction again, always sanction!
The principle that almost everyone, no matter how well-trained and resilient in personality terms, will suffer the adverse consequences of exposure to high-stress situations and will benefit from psychological debriefing as a first-aid measure had now well-and-truly sunk intothe collective philosophy of the British military. In parallel, the civilian emergency services have now embarked upon the same quest - the development of a workable and acceptable system to offer debriefing as, quite simply, part of the normal modus operandi, as part of the normal pattern of work for those inevitably involved in high stress-exposure situations as part of their jobs.
The release of the British hostages from the Middle-East, a process ongoing, provided evidence that "debriefing" had assumed a mantle of respectability even in the lofty circles of government. John McCarthy and then Jack Mann and their families were debriefed in Britain upon their release. Terry Waite's release hopefully will be soon.
It has proved to be a momentous year, starting last September in a plane-trip full of dreams of just being in California - the realisation of a very long-held ambition. It seems to have been a catalyst to much more than I could have expected or hoped.
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