For many military veterans, returning from war zones can lead to Post Traumatic Stress Disorder. Symptoms of PTSD can be varied, and veterans may feel disconnected from loved ones and emotionally numb. They often think they will never feel "normal" again. This is why it's difficult to live with untreated PTSD, as there seems to be no light at the end of the tunnel.
Now, traditional medicine is being complemented by a form of occupational therapy known as surf therapy. Being in the ocean, paddling through the whitewater, occasional wipeouts and riding down the face of the waves are helping former soldiers, sailors and pilots return to normal.
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How serious is PTSD among war veterans?
Research shows military veterans with PTSD are up to five times more likely to suffer from a major depressive disorder. The stark figure has been reached after compiling statistics from an analysis of 57 studies across the military and civilian population.
The condition occurs after a person experiences a life-threatening event or severe trauma. While it's a normal reaction for your mind and body to go into shock, this temporary response becomes PTSD when the victim's nervous system gets "stuck" in shock mode. Many veterans have symptoms that include insomnia, feelings of isolation, anger and a lack of confidence.
In the 1980s, the National Vietnam Veterans' Readjustment Study revealed 74% of Vietnam vets diagnosed with PTSD had turned to substance abuse. In a study of more recent veterans, of those with PTSD, 63% had abused alcohol or drugs.
Up to 35% of veterans returning from Afghanistan and Iraq often reported chronic pain, as well as feelings of PTSD, leading to suggestions they were linked, with the emotional scars resurfacing as physical pain.
How does surf therapy help combat PTSD?
Run by the Jimmy Miller Memorial Foundation, the world's first surf therapy programme aims to heal mental and physical illnesses through surfing. Set up at Manhattan Beach, California, it honours the memory of popular surfer Jimmy Miller, who tragically committed suicide in 2004, after suffering mental health issues.
After suffering a shoulder injury that prevented him from surfing, he became increasingly depressed and sadly ended his own life. His friends at the foundation believed he would have won his battle against mental illness, had he been able to carry on surfing.
The concept of surf therapy was the brainchild of Miller's friend, Dr Carly Rogers, who was completing her Master’s degree in Occupational Therapy at the University of Southern California at the time.
Initially, the surfing programme was launched in 2005 to help abused children in Los Angeles, where the results were described as "beyond remarkable" in helping them get over severe trauma. It was expanded to include war veterans with PTSD in 2007. Rogers runs the therapy classes herself and has helped hundreds of vets of all ages.
She had no experience with the military initially and wasn't sure how it would work out. When she met her first class of veterans from the conflicts in Iraq and Afghanistan, they were described as "withdrawn, with little expression" - but that soon changed. After just one full day of surfing, the veterans were already "smiling, joking and high-fiving". Rogers built on the experience by working at the Veterans' Administration to research PTSD and provide as much help as possible through surfing.
Each group meets over five consecutive Saturdays on the beach. At the outset, Rogers asks the veterans to chat about their experiences before they wade into the surf with their volunteer instructors. Each week, the session starts with an informal talk on the beach to ask the vets how they are progressing, before enjoying a few hours' surfing.
Is there surf therapy in the UK?
While the idea started in the United States, surf therapy also takes place in Redruth, Cornwall, thanks to Gulf War veteran Rich Emerson, of Sennen, who launched Surf Action in 2009. The social enterprise group specialises in surf therapy to help physically and mentally scarred ex-servicemen.
Emerson served with the Queen's Royal Irish Hussars from the age of 22, including in Operation Desert Storm during the Gulf War in 1990 and 1991. The keen sportsman enjoyed army life and became a physical training instructor. However, after leaving the military in 1993, his life began to spiral out of control.
The father-of-four exhibited erratic and anti-social behaviour that contributed to his two divorces. He began having nightmares about the terrible things he had seen in Kuwait during the war, gradually getting into a self-destructive lifestyle of excess drinking, suicidal thoughts and depression.
At the time, neither Emerson nor anyone around him knew anything about PTSD and it took him years to realise this was the root of his problem. He was 30 before he started getting his life back on track. He had been on a trip to California, where he bumped into surfer Ben Marcus at a charity sale in Malibu Creek.
Marcus was selling old surfboards and wetsuits to raise money for the California-based organisation, Operation Amped, to support injured American veterans and their families. Emerson chatted to him about the healing potential of surfing.
When visiting his first wife and children in Cornwall, the idea of Surf Action was born. Describing how he saw the "solid, clean surf" at Porthmeor Beach in St Ives (a popular spot for surfers), something struck a chord and Emerson thought, "That's what I want to do."
He bought his first board and wetsuit, learned to surf and moved to Cornwall so he could surf all the time. The sport gave him a new sense of purpose, so he decided to put his energy into helping other war veterans to recover in the same way.
His charity, Surf Action, helps former soldiers who have left frontline combat and are struggling to come to terms with civilian life. The programme helps veterans and their families by holding regular surfing days.
Emerson and his colleagues (all qualified surfing instructors) believe surfing is great therapy for people dragged down by their horrific experiences in war zones. His story has been made into a TV documentary by Channel 5, called Battle Scarred: Soldiers Behind Bars.
There are several reasons why surfing is so useful for treating PTSD. First, water is generally considered to have a calming, healing effect on the body and mind, for reasons psychologists can't fully explain.
Surfing is a chance to enjoy a fun activity, taking your mind off your problems and helping to relieve stress and tension. Sitting at home worrying and staring at the same four walls makes it difficult to break out of the cycle of depression.
Learning to surf means you're focusing your thoughts on something unrelated to your troubles. It's a positive experience where participants can feel pure joy again. You can be alone on the waves, or socialise with those around you. There are no age barriers, so no-one should feel excluded, as it's a sport for all.
Surfing is also a tiring sport, as it requires physical exertion. This means you fall asleep quicker at night. A lot of people with PTSD suffer from insomnia, so when surfing physically tires them out, there's more chance they will sleep for a healing eight hours without medication.
Finally, medical evidence suggests movement and physical effort naturally encourage metabolic processes to begin within our brain. The physical exercise starts to have a healing effect on our mind and body simultaneously.
When was PTSD first recognised among veterans?
While PTSD is a relatively modern description of the debilitating stress suffered by battle veterans, it's a condition that goes back many years, although it hasn't always been officially recognised.
It was mentioned by the Greek historian, Herodotus, who described the Battle of Marathon in 490 BC. After an Athenian warrior was killed in battle, the soldier standing next to him, who was uninjured, began suffering symptoms that we recognise today as PTSD.
During the American Civil War, from 1861 to 1865, rapid-fire rifles and other new weapons significantly increased the destructiveness of the battle, leaving the soldiers with physical and psychological scars. Jacob Mendez Da Costa, an assistant surgeon in the US Army at the time, studied the veterans' health problems and later described a condition like PTSD that was known as Da Costa’s Syndrome.
Known as "shell shock" during World War 1, during World War 2, it became known as "battle fatigue" and later it was called "post-Vietnam syndrome".
The official research and recognition of PTSD began in the late 1970s and led to a mention in the 1980 study, Diagnostic and Statistical Manual of Mental Disorders. Since the official diagnosis, as many as 500,000 Iraq and Afghanistan veterans were diagnosed with PTSD over a period of 13 years. Since the condition has been recognised only recently, it's impossible to say whether mental health problems and PTSD have worsened in modern conflict, as there are no statistics for previous wars.
Surfing during World War 2
Long before surfing therapy became a recognised occupational therapy, soldiers recognised its beneficial nature as long ago as the Second World War.
Albert "Rabbit" Kekai, a famous American pro-surfer born in Honolulu in 1920, served in the military during WW2. He was fortunate to be stationed in Haleiwa during his military service. He served for three years on the US Underwater Demolition Teams, operating the Pacific Theatre, where he deployed depth charges to destroy Japanese ships.
After the war, Kekai described the pleasure of going surfing for relaxation after finishing his duties for the day. He went on to found the famous Waikiki Surf Club and remained an avid surfer until his death in 2016 at the age of 96.
Coincidentally, during WW2, the need for lighter aircraft revolutionised surfing, as the balsa wood material blended with fibreglass that was used for the new planes turned out to be an ideal material for surfboards, replacing the earlier boards that were made from heavy and unwieldy woods.
We will remember them
On the 11th November, Ocean Magic will be observing the two-minute silence as a mark of our respect for those who fought and lost their lives during times of conflict. We will always remember them.