The Long Shadow: Australia's Vietnam Veterans Since the War

By Peter Yule

'Most veterans were either alcoholics or workaholics and I fitted into the latter category' —Chris Cannin (6RAR, 1967; 7RAR, 1967-68). 'When I look back and I see what I used to do ... there were a lot of things wrong that I would never ever admit to at the time ... I thought I was fine, but I wasn't' — Alan Thornton (17 CONSTRUCTION SQUADRON, 1968–69). The medical and psychological legacies of the Vietnam War are major and continuing issues for veterans, their families, and the community, yet the facts about the impact of Agent Orange, post-traumatic stress disorder, and other long-term health aspects are little understood. The Long Shadow sets the record straight about the health of Vietnam veterans and reveals a more detailed and complex picture. Profiling the stories of the veterans themselves, this comprehensive and authoritative book is a pioneering work of history on the aftermath of war. It takes a broad approach to the medical legacies, exploring the post-war experiences of Vietnam veterans, the evolution and development of the repatriation system in the post-Vietnam decades and the evolving medical understanding of veterans' health issues.

• Language: English
• Publisher: NewSouth
• Release date: Nov 13, 2020
• ISBN: 9781742245034

Book preview

THE

LONG

SHADOW

THE

LONG

SHADOW

AUSTRALIA’S VIETNAM

VETERANS SINCE THE WAR

PETER YULE

FOREWORD BY GENERAL SIR PETER GOSGROVE

A NewSouth book

Published by

NewSouth Publishing

University of New South Wales Press Ltd

University of New South Wales

Sydney NSW 2052

AUSTRALIA

newsouthpublishing.com

Published in association with the Australian War Memorial.

© Australian War Memorial 2020

First published 2020

10 9 8 7 6 5 4 3 2 1

This book is copyright. Apart from any fair dealing for the purpose of private study, research, criticism or review, as permitted under the Copyright Act, no part of this book may be reproduced by any process without written permission. Inquiries should be addressed to the publisher.

ISBN9781742237183 (hardback)

9781742245034 (ebook)

9781742249469 (ePDF)

Internal design Josephine Pajor-Markus

Cover design Peter Long

Cover image Australian troops look on as an airstrike hits suspected enemy positions in the Long Hai hills, Phuoc Tuy province, August 1969. Photo: Christopher John Bellis. AWM BEL/69/0519/VN

Front endpaper image Corporal Graham Pashley of 7RAR is rushed to a helicopter for evacuation after collapsing from heat exhaustion in November 1967. Photo: Michael Coleridge AWM COL/67/1106/VN

Back endpaper image Many veterans were stunned by the enthusiasm of the crowd at the Sydney Welcome Home march on 3 October 1987. Photo: Peter West. AWM PAIU1987/230.33

Printer Everbest

All reasonable efforts were taken to obtain permission to use copyright material reproduced in this book, but in some cases copyright could not be traced. The author welcomes information in this regard.

This book is printed on paper using fibre supplied from plantation or sustainably managed forests.

CONTENTS

Foreword

Preface and Acknowledgements

1The Medical Legacies of War

2‘We Will Look After Your Welfare’: The Legacy of the First World War

3Repatriation Policy and Practice, 1939–62

4‘It Was All an Adventure’: Australian Forces in Vietnam

5Fighting the War in Vietnam

6Medical Issues of the Vietnam War

7Return from Vietnam

8The Decade of Silence

9The Beginnings of the Agent Orange Controversy

10Australian Veterans and Agent Orange

11Australian Forces and Chemical Exposure in Vietnam

12The Senate Inquiry and the First Epidemiological Studies

13The Evatt Royal Commission

14Post-Vietnam Syndrome and PTSD: The Mental Health of Vietnam Veterans in the 1980s

15The Health of Veterans and Their Families in the 1980s

16Fight it Case by Case

17Science v Politics: The Turning Point in the Agent Orange Debate, 1988–2000

18F.B. Smith’s Official History

19Hitting the Wall: Veterans and Their Families, 1988–2000

20Asking the Veterans: The Self-reported Study of the 1990s

21The Mental Health of Vietnam Veterans in the 1990s

22The Physical Health of Vietnam Veterans, 1988–2000

23‘Everyone Has Their Way of Coping’: Australia’s Vietnam Veterans since 2000

24The Physical Health of Vietnam Veterans since 2000

25Agent Orange and Dioxin: Exposure and Health Effects

26The Mental Health of Vietnam Veterans and Their Families since 2000

27War without Purpose, War without End

Bibliography

Notes

Index

LIST OF TABLES AND FIGURES

FOREWORD

The manuscript of The Long Shadow arrived in the mail during the 2020 coronavirus lockdown period. In common with most of you, that time of social isolation was a perfect opportunity to read and ponder. For me, in one sense the isolation was a bit of a bust because I had been looking forward greatly to my first Anzac Day since retiring as Governor-General, to participate in the march in Sydney with my old mob, the 9RAR Association, the battalion with which I served in Vietnam. The march, like all large public gatherings, went by the board in April 2020.

When I first picked up The Long Shadow, noting its length and great detail on the subject of Australia’s Vietnam veterans since the war’, I thought I would read it over four or five days, but once I started, I read it through in one go. I couldn’t put it down. In this major work, a defining account of those men and women who served in the Vietnam War and their challenges in its aftermath, Peter Yule has combined empathy, insight and forensic research of the highest order.

Peter has not attempted to write a history of the war operations in which Australians participated, but his references to that aspect of veterans’ experiences ring true in every case. But that is not his emphasis – rather, it is what followed. His account is of nearly five decades of suffering and angst, policy and research concerning the health and welfare of Vietnam veterans. He sets the scene vividly and persuasively for a comprehensive analysis and occasional deconstruction of popular impressions and a flawed policy about the war and the veterans who experienced it. I found myself cheering him on as I read his account of the long years of struggle by the veterans to urge for recognition of disabilities and the slow adjustment by the nation’s supporting systems. He set out to give an account that included the voices of veterans, and in this he has succeeded marvellously well.

If you are a Vietnam veteran, you are now in your senior years and many of your fellow veterans have passed. Indeed, you will know of many, who for one reason or another, are in poor shape. The Long Shadow helps us all – veterans, their loved ones, veterans’ supporting agencies and the wider community – to understand the effects of a war like that of Vietnam, embraced by the veterans as part of their duty at the time, endured by them for the rest of their lives, in the aftermath.

There are many books about the Vietnam War: the war at large, Australians in that war, and a great number of individual stories. None go as close as The Long Shadow to telling us of the most significant, lingering impact on Australia – on our veterans.

I commend this excellent account for those who would understand the impact of wars on those who fight them. The prism might be Vietnam, but the landscape beyond is universal.

Congratulations, Peter Yule!

General the Honourable Sir Peter Cosgrove AK AC (Mil)

CVO MC (RETD)

(9RAR, 1969; HQ 1ATF, 1969–70)

June 2020

PREFACE AND ACKNOWLEDGEMENTS

The Vietnam War continues to cast a long shadow over a generation of former servicemen and women. Five decades after their service in Vietnam many veterans and their families live with the enduring impacts of that disastrous war. Wars have always had a lasting effect on the lives of those who have fought in them, but rarely, if ever, have the legacies of war been the subject of such public and divisive debate as Vietnam. The futility of the war, the rejection of veterans on their return, the Agent Orange controversy and the slowly growing understanding of PTSD as a mental health condition all contributed to making the post-war experience of Vietnam veterans very different from those of veterans of Australia’s earlier wars.

The controversies over veterans’ health have had wide repercussions, even affecting the relationship between Vietnam veterans and the Australian War Memorial. Many veterans were angered by the tone and conclusions of Professor F.B. Smith’s essay, Agent Orange: The Australian Aftermath’, in Medicine at War, the medical history volume of the official history of Australia in the Vietnam War, published by the War Memorial in 1994. Similarly, veterans disagreed with the wording of a plaque on the use and effects of Agent Orange in a new gallery at the Memorial opened in 2008. Veterans’ organisations campaigned to have the plaque rewritten and, at the same time, renewed their calls for the official history to be rewritten. The AWM Council believed it would set an unfortunate precedent to rewrite an official history, but acted on the suggestion of the official historian, Professor Peter Edwards, to commission a new independent history to examine all the issues around Vietnam veterans’ health. This volume is the outcome of that decision.

I am grateful to the then Director of the AWM, Dr Brendan Nelson, Chairman of the AWM Council, Kerry Stokes, and all members of the Council for commissioning me to write this history. Their only request was to ensure that ‘the voices of the veterans are heard’. I can state categorically that they have kept to their undertaking that the history would be independent. Neither the Council nor any members of the AWM staff have attempted to influence my findings in any way. The conclusions, right or wrong, are mine alone based on my appraisal of the evidence. I do not expect that all my conclusions will be welcomed or accepted by all veterans, but I trust that they will believe that they have been honestly arrived at based on interviews with many veterans, wide reading of veterans’ memoirs, and a comprehensive review of the scientific and medical literature.

I owe thanks to many people for their help and support while researching and writing this book. My greatest debt is due to the veterans who were interviewed for this project and the many other veterans and their family members I spoke with. Their experiences and views varied greatly but they all spoke honestly and openly about the war and its impact on their lives. They did what their country asked of them and many have suffered life-long consequences as a result.

So many people helped with this project that it is invidious to single out individuals, but some deserve particular acknowledgement. Graham Walker first contacted me on the day the project was announced, and he has since provided me with a vast amount of material to ensure that I was given a complete picture of the history of veterans’ health concerns. He will doubtless also be the first to point out any weaknesses in my arguments. Many other past and present leaders of the veterans’ organisations have given the project great support, including Ken Foster, Max Ball, Graham Anderson, the late Peter Ryan, the late Tim McCombe, Bill Roberts, Frank Cole, Ian Thompson and James Wain. Bernie Szapiel, Gary and Sandra Adams, and the late Holt McMinn helped clarify the events of the early years of the Vietnam Veterans Association. I have also gained greatly from conversations over many years with Tom Goode, the first Vietnam veteran I ever met, back in ‘the decade of silence’. My thanks also to Jack Thurgar, who assisted with post-war photographs.

Many staff members at the War Memorial assisted with the project. Anne Bennie was constantly supportive in her oversight of the financial and administrative aspects, the staff of the Research Centre assisted with access to their wonderful collection, Ally Roche, Kate Dethridge, Lauren Hewitt and the Multimedia team helped greatly with the photographs, and Ron Schroer and Matthew Oliver guided the book towards publication. The members of the Military History section provided welcome collegiality and encouragement, and Ashley Ekins, former head of Military History, was generous in sharing his vast knowledge of the Vietnam War.

Dr Michael Fett read and analysed hundreds of medical and scientific publications and helped me make sense of the vast number of studies of the health of Vietnam veterans. While I have not always agreed with his conclusions, the project would have been almost impossible without his contribution. The four historians who carried out interviews with Vietnam veterans around Australia – Tristan Moss, Miesje de Vogel, Serge DeSilva-Ranasinghe and Fay Woodhouse – performed their task with skill and sensitivity, as did Gonzalo Villanueva, who proofread the manuscript.

NewSouth Publishing has been a pleasure to work with. Elspeth Menzies, Emma Hutchinson, Rosie Marson and John Mapps have produced the book with skill, efficiency and enthusiasm and I thank them for their contribution.

The staff of the Department of Veterans’ Affairs have been unfailingly helpful. In particular, I thank Simon Lewis, Liz Cosson, Lisa Shepherd, Mark Neal, Joanne Wagner, Glen Yeomans, Pete Donaldson, Kate Tunks and Natalie Hubner for their assistance. A special thanks also to Jannine Dixon for her friendly welcome to the DVA repository in Port Melbourne – starting work at 7 a.m. can lead to a great boost in productivity. Former Department of Veterans’ Affairs staff, notably Ewan Letts, Bruce Manning, Derek Volker and Dr Graeme Killer, all gave invaluable assistance, as did the former minister, Tony Messner.

My thanks to the staff at the National Archives reading rooms in Canberra and Melbourne, especially Michael Wenke, and the staff in the Manuscripts and Newspapers reading rooms at the National Library for their unfailing professionalism and willingness to go beyond the call of duty.

Many experts shared their knowledge with me, notably Professor Sandy McFarlane, Professor Ben Selinger, Dr Brian O’Toole, Professor Peter Edwards, and the Military Operations Analysis Team at UNSW (ADFA), Derrill de Heer, Bob Hall, Andrew Ross and Peter Kimberley. The insights I gained from doctors and nurses who served in Vietnam were invaluable, and I thank Dr Bill Rogers, Dr John Pearn, Dr Mike Naughton, June Naughton (Miinchow), Dr Guy Hutchinson, Dr Bert Newman and Dr Rod Bain.

My final thanks go to Craig Tibbitts. His official title was ‘Research Project Manager’, but this title is far from adequate to describe the wide range of tasks he completed with quiet efficiency. He carried out a vast amount of research in both primary and secondary sources, liaised with DVA and other government departments, and handled the administrative side of the project without fuss or bother. His deep knowledge of the history of military medicine and the psychological wounds of war was especially helpful. Any request I made, however difficult or misguided, met with a quick and effective response. Craig made innumerable helpful suggestions and saved me from many errors.

I have learnt a great deal during the course of this project. Most of all I have learnt to admire and respect the quiet courage of the Vietnam veterans and their families I have had the privilege to meet. Many veterans believe their service and sacrifice have never been fully recognised and that their health problems have been ignored, trivialised or denied altogether. My hope is that this book will help to ensure that their voices are heard.

Peter Yule

1

THE MEDICAL LEGACIES OF WAR

Since the emergence of the first organised human societies, countless millions have been killed in wars, but even more have been left maimed, crippled and traumatised. Every war has left its medical legacies of physically and mentally wounded soldiers. The legacy of physical wounds is usually obvious, but war has always resulted in mental trauma. Homer’s evocative accounts of the realities of battle and its aftermath in his epic tales of the Trojan War show that the experience of combat had a profound impact on the soldiers of ancient Greece. Many of the syndromes identified in modern combat veterans could be seen in the characters in the Iliad and the Odyssey, such as feelings of betrayal, survivor guilt, emotional numbing and the trauma of homecoming.¹

The Romans, whose armies dominated the ancient world for hundreds of years, kept excellent records of soldiers’ health, and these show that Roman soldiers suffered many conditions brought on by combat stress.² The Romans also had the first organised system for caring for veterans, with land grants and tax relief. Later, under the Byzantine Empire, hospitals were established for the long-term care of disabled soldiers.³

In medieval Europe wars were frequent and the physically disabled survivors of warfare would have been a familiar sight. Their care was left to families or charities, particularly the monasteries. But what of the mentally disabled? It has been argued that the incidence of war-induced trauma would have been less in medieval times than in modern societies because battles were generally brief and people were more accustomed to hardship and random violence in everyday life.⁴ There are some clear examples of war-caused trauma, but perhaps fewer than might be expected if post-traumatic stress disorder (PTSD) was widespread among medieval war veterans.⁵

The introduction of gunpowder weapons in Europe led to great changes in the wounds received in battle and consequently to the physical legacies of war. The increased impact energy of cannons and muskets caused a steep rise in the number of compound fractures, leading to an increase in amputations. Although the survival rate was low – probably less than 25% – the number of amputee war veterans rose sharply.⁶

Before the 17th century, few countries had organised systems for the care of disabled soldiers, with families and charities bearing the burden and many veterans being forced to beg or steal to survive. The notable exception was Switzerland, where it was common practice from as early as 1339 to use public funds to care for sick and wounded veterans.⁷ From the 17th century more governments began to provide care for veterans. Perhaps the most comprehensive system was that developed in the English Civil War when the Parliament accepted ‘full centralised responsibility for those killed or incapacitated in its service’. Wounded were well cared for by the standards of the time, and disabled soldiers, widows and orphans were given generous pensions. The system was expensive to operate and by 1654 the cost of caring for ‘lame soldiers and widows’ was £50,000 per month, out of a total allocation for the armed forces of £116,000.⁸ The emphasis was on the care of the physically disabled but there are surviving hospital records of ‘poor distracted’ patients whose care consisted of sedation, bleeding and the prevention of self-harm’.⁹

In the late 17th century both England and France introduced new measures for the care of war veterans. In France, Louis XIV set up the Hôtel Royal des Invalides, a hospital ‘for the support and succour of soldiers wounded or disabled in war’, and in England Charles II established the Royal Chelsea Hospital for elderly and disabled veterans. Louis XIV stated a proposition echoed by many governments, though few have acted on it: ‘It is right and proper that soldiers, who by reason of the wounds they have received in war or by virtue of their long service or their age are no longer able to work or earn their living, should be properly sustained for the rest of their days’.¹⁰

The scale of warfare and the number of casualties increased exponentially in the French Revolutionary and Napoleonic Wars, which saw near-constant warfare in Europe from 1792 to 1815. France, from a population of about 28 million in 1792 suffered some 1.4 million military deaths by the end of the wars, while the United Kingdom lost over 300,000 from a population of 15 million.¹¹ These figures are probably an underestimation as ‘so many men died before their time from the effects of the campaigns’.¹²

For those wounded in battle during the Napoleonic Wars, the outlook was bleak. Although recovery of the wounded from the battlefield was generally better organised than in earlier wars, surgery without anaesthesia or antiseptics was painful, risky and often fatal. Wounds to the chest, abdomen or hip joint were almost invariably fatal. Amputation was still the standard treatment for almost all serious limb wounds, with mortality rates between one-quarter and one-third.¹³ Those who survived were largely condemned to lives of pain and poverty.

Even many less serious wounds could have long-term adverse consequences for the victim. The slightest wound could lead to tetanus, which was almost always fatal. Musket ball wounds of the joints, if they did not lead to amputation, would usually result in ankylosis – a stiff and immovable joint, often accompanied by long-term, serious pain. As in all wars since the introduction of gunpowder, hearing loss was another common injury.

There are surprisingly few accounts of war-induced mental trauma from the wars of 1792–1815. The most commonly described mental illness was ‘nostalgia’, an extreme form of emotional fatigue marked by feelings of frustration and isolation that rendered soldiers listless and unable to concentrate, and, in extreme cases, virtually helpless.¹⁴ Swiss physician Johannes Hofer coined the term ‘nostalgia’ in 1688 to describe chronic homesickness, and it was not a specifically military problem, except in so far as soldiers were often away from their homes for lengthy periods.¹⁵ However, during the Napoleonic Wars French military doctors reported epidemics of nostalgia among French armies, notably during the retreat from Moscow in 1812.¹⁶ After the war, Dominique Larrey, the outstanding surgeon of the Napoleonic Wars, published a study of nostalgia, which he described as a form of ‘mental aberration’ that caused ‘prostration of strength’ and ‘melancholy’ leading to death by suicide or exhaustion in extreme cases.¹⁷ ‘Nostalgia’ appears to have been described only among French soldiers, but British doctors possibly diagnosed similar symptoms as ‘melancholia’.¹⁸

During the 19th century the treatment of war wounds improved significantly as a result of dramatic breakthroughs in medicine, notably anaesthesia and antiseptics. Anaesthesia revolutionised all military surgery, especially battlefield amputation. Speed was no longer essential, enabling more careful surgery, and deaths from surgical shock were greatly reduced.¹⁹ Anaesthetics were first widely used in the Crimean War, although the war was otherwise a medical disaster, with deaths from infections and disease far exceeding the number of those who died in battle. Responding to the appalling conditions that led to the high death rates, Florence Nightingale demonstrated that simple attention to cleanliness in hospitals could greatly reduce mortality.²⁰ Following this empirical demonstration, Louis Pasteur provided the theoretical basis by proving that infections were caused by bacteria, which in turn encouraged Joseph Lister’s development of aseptic surgery. The adoption of the methods of Lister and Nightingale saw the Prussian Army in the Franco-Prussian War of 1870–71 become probably the first army in history to lose more soldiers in battle than through disease and infections.²¹ Even in the American Civil War in the 1860s, more than twice as many soldiers died of disease as died in action or of wounds.²²

The American Civil War is the first major war for which we have more than anecdotal accounts of psychiatric casualties, as there are comprehensive medical records that have been extensively researched by historians. Quite early in the war, Union Army doctors were confronted with large numbers of soldiers suffering obvious mental illness. Many were simply diagnosed as ‘insane’, but a large number displayed symptoms that led doctors to turn to Hofer’s term ‘nostalgia’ to describe them.²³ Other psychiatric conditions among Civil War soldiers were variously described as ‘exhausted hearts’, ‘hysterical paralysis’, ‘war tremors’ and ‘epilepsy’. There were many cases of conversion reactions, that is, showing the symptoms of physical ailments such as deafness, blindness or paralysis, with no physiological basis.²⁴ One conversion reaction that was closely studied in the Civil War was ‘Da Costa’s syndrome’, named for Dr Jacob Da Costa who published a study of 300 soldiers suffering ‘irritable heart’.²⁵ The main symptoms were shortness of breath, palpitations and sharp chest pains, for which there appeared to be no physiological explanation.

For earlier wars, knowledge of the post-war fate of veterans is incidental and anecdotal, but the medical legacies of the American Civil War have been extensively studied.²⁶ On their return, many veterans were restless, missing their wartime comrades and the constant movement and action of the war years. They deeply mistrusted civilians, and civilians in turn were wary of the returning soldiers, scared they were bringing home disease and ‘moral maladies’. Large numbers of veterans returned with alcohol or drug addictions and many were unable to get employment, especially the more than 25,000 who had lost a limb. There were many suicides among veterans in the immediate post-war years as they struggled to find a place in civilian society. Many veterans suffered chronic ill-health from the ‘exertions, privations and anxieties’ of military service. An army medical inspector collected statistics from the veterans of Massachusetts to show that ‘veterans were significantly more likely than non-veterans to suffer from chronic illnesses and disease’, particularly tuberculosis, rheumatism, heart disease and chronic diarrhoea, as well as nervous disorders and insanity.²⁷

Several recent historians have criticised what they see as an overly negative view of veterans’ experiences after the Civil War. Paul A. Cimbala, for example, argues that a large majority of veterans survived the horrors and hardship of war with surprising resilience and went on to become productive members of society.²⁸ Reviewing Cimbala’s book, Brian Jordan argues that even if the travails of Civil War veterans have been overstated, the evidence still shows that ‘neither Johnny Reb nor Billy Yank ever successfully escaped the war’s shadow’.²⁹

Although military doctors in the American Civil War diagnosed many cases of mental illness, little was offered in the way of treatment. Insane soldiers were routinely discharged and left to wander the countryside or find their way home as best they could. It was not until the Russo-Japanese War of 1904–05 that significant progress was made in the treatment of psychiatric casualties. The Russian army had lost many soldiers to mental trauma during the Crimean War, and Russian psychiatrists maintained their interest in battle shock. Consequently, when many Russian soldiers fighting the Japanese began to show signs of psychiatric collapse, Russian doctors treated it as a medical condition caused by the stress of war, rather than malingering or a sign of personal weakness. Their attempts to treat psychiatric casualties ‘laid the foundations of modern military psychiatry’.³⁰ The Russians established many of the diagnostic categories that were adopted by other army medical services in the First World War, recording cases of hysterical excitement, confused states, hysterical blindness, anxiety induced dumbness, local paralysis and ‘neurasthenia’. Over half the Russian psychiatric casualties were diagnosed as having some form of traumatic damage to the brain, foreshadowing the ‘shell shock’ of the First World War.³¹

Early in the war, the Russian doctors evacuated psychiatric casualties in the same way as those who were physically wounded, but this led to a massive increase in the number of psychiatric casualties. When soldiers saw that their mentally traumatised comrades were being evacuated from the front lines, they, consciously or unconsciously, began to exhibit similar psychiatric symptoms in order to escape the ordeal of battle. This led the doctors to establish the principle of proximity, whereby psychiatric casualties were treated close to the front line, being told from the start that they would be returning to battle.³²

War has always left a legacy of physically and mentally wounded soldiers. Long after the sounds of battle have died away, the sufferings of those who fought have continued. The physically disabled faced lives of pain and poverty, but their empty sleeves or blinded eyes might gain some sympathy and support. However, from the anguish of Achilles after the death of a comrade in the Trojan War to those driven mad in the slaughter of the American Civil War, the mentally traumatised victims of war were usually faced with total lack of understanding of their condition. At best they endured the mirth and contempt of civilians; at worst they would be locked away, possibly for life, in jails or lunatic asylums. The lives of many veterans ended in an alcoholic haze or suicide.

2

‘WE WILL LOOK AFTER YOUR WELFARE’: THE LEGACY OF THE FIRST WORLD WAR

The First World War dwarfed all previous wars in the size of the armies involved and in the number of casualties. Between August 1914 and November 1918 more than 60 million soldiers were mobilised in 32 nations around the world. About 9.5 million soldiers died and a further 20 million were wounded. Millions were left horribly disfigured, physically disabled or psychologically damaged.¹

The rapid development of technology over the previous century meant that weapons on the First World War battlefields had vastly increased destructive power. The opposing armies had field guns and heavy guns by the thousands, capable of firing high explosive, shrapnel and poison gas up to 10,000 metres. Rifles had greatly increased in range and power, but far more influential was the invention of the machine gun. A well-trained rifleman could fire about 15 bullets a minute, but a machine gun fired up to 600. It was almost impossible for attacking infantry to survive a frontal attack across open ground against a machine gun position.

Over the whole war, however, far more soldiers were killed and wounded by artillery than bullets. In earlier wars, soldiers had been subjected to lengthy bombardments but never anything to match the intensity and destructiveness experienced in the First World War. For soldiers subjected to bombardment the impact was terrifying. After the Battle of Pozières, where Australian troops endured sustained shellfire for days on end, Lance Corporal Archie Barwick wrote:

All day long the ground rocked and swayed backwards & forwards from the concussion of this frightful bombardment … any amount of men were driven stark staring mad & more than one of them rushed out of the trench over towards the Germans, any amount of them could be seen crying & sobbing like children their nerves completely gone, how on earth we stood it God alone knows, we were nearly all in a state of silliness & half dazed.²

Stephen Garton argues that the First World War was qualitatively different from earlier wars, rather than just being fought on a bigger scale. This was due to the greatly increased destructive power of weapons, the traumatic impact of being subjected to sustained bombardment with no ability to fight back or flee, and the ‘grim realisation that modern weapons could in an instant destroy all bodily trace’.³ This changed nature of warfare led to large and unexpected number of psychiatric casualties in all armies from early in the war.

The common symptoms of the traumatised soldiers left military psychiatrists perplexed, with patients ‘suffering from debilitating shakes, stutters, tics and tremors, and dramatic disorders of sight, hearing and gait’.⁴ These were ‘conversion disorders’, that is physical disabilities that did not have obvious physical causes.⁵ In addition, thousands of soldiers disabled by fatigue, lassitude, headaches, hysteria and confusion were diagnosed with ‘neurasthenia’. Faced with large numbers of soldiers with similar symptoms, doctors speculated that the concussive effects of shelling were causing physical damage to the brain. From early 1915 the term ‘shell shock’ came into widespread use as a general term for most war-related psychiatric disturbances.⁶ The concept of brain injury as the primary reason for psychiatric casualties was quickly rejected by most psychiatrists, as they observed that some soldiers suffering from ‘shell shock’ had not been exposed to shell fire and some had not even been in the front line. By 1916, the general opinion among psychiatrists was that ‘the vast majority of these cases, if not all, were due to psychic shock and not to physical shock.⁷ British Army psychiatrist Harold Wiltshire in a study of 142 cases of ‘shell shock’ concluded that:

Gradual psychic exhaustion from continued fear is an important disposing cause of shell shock, particularly in men of neuropathic predisposition. In such subjects it may suffice to cause shell shock per se.

In the vast majority of cases of shell shock the exciting cause is some special psychic shock. Horrible sights are the most frequent and potent factor in the production of this shock. Losses and the fright of being buried are also important in this respect …

Any psychic shock or strain may cause a functional neurosis, provided it be of sufficient intensity relative to the nerve resistance of the individual.⁸

Initially German doctors also assumed that traumatised soldiers were suffering from physical damage to the brain caused by shell fire. Consequently, treatments were based on keeping patients calm and rested, and putting them to work in farms and forests. Many soldiers were discharged from the army and given pensions.⁹ However, German psychiatrists soon decided that war neuroses were a mental not physical problem, arising not from the traumatic shock of battle but the conscious or unconscious desire to escape from the front line, together with the lure of a disability pension. Further, they argued that only soldiers with underlying psychological weaknesses suffered from war neuroses, which ‘were the hysterical reactions of fearful, weak-willed or lazy men, who in most cases would have broken down anyway’.¹⁰

The attention of psychiatrists and military doctors in all armies during the First World War focused on shell shock and related conversion disorders, in much the same way as PTSD has been the focus of attention in the decades since the Vietnam War. This leads to the question: is shell shock the same as post-traumatic stress disorder?¹¹ The short answer is that there are fundamental differences between them. The symptoms of shell shock appeared as an immediate response to the stress of battle, while, as the word ‘post’ implies, the symptoms of PTSD appear well after combat, in many cases decades later. The symptoms of shell shock also differ greatly from PTSD. In particular, the conversion disorders common among victims of shell shock are rare among PTSD sufferers.

***

For Australia, a new nation of less than five million people far from the main seat of conflict, the First World War was both a nation-forming and nearly nation-breaking experience. Overwhelming early enthusiasm for the war prompted a surge of volunteers for the Australian Imperial Force (AIF), with enlistments eventually totalling over 400,000. The average age on enlistment was 26.4 years, making the AIF distinctly older than the Australian force in Vietnam, and medical examinations were often cursory, so the ‘healthy soldier effect’ was probably not as pronounced after the First World War as after the Vietnam War. The healthy soldier effect refers to the significant decreased all-cause mortality and better general health outcomes usually observed in soldiers compared to the rest of the population due to the rejection of unhealthy individuals in the recruiting process and the beneficial effects of intense physical training.

The national unity of 1914 and 1915 faded as casualties mounted. With the number of volunteers falling, the government’s call for conscription was twice defeated in referendums, leading to a bitter split in the Labor Party. In 1917 the economy was rocked by a wave of strikes that shut down the railways, coal mines and other key industries, and the trade union movement and the Labor Party began to call for peace rather than victory.¹² It is a mistake to think that soldiers at the front received universal support from home in the First World War.

The AIF suffered appalling casualties. In one night at Fromelles on 19–20 July 1916, the 5th Division lost nearly 2000 killed, over 3000 wounded and 470 prisoners of war.¹³ The 60th Battalion went into the battle 887 strong and lost 757 killed and wounded. The final number of Australian casualties is still subject to debate, however the most up-to-date figures are 61,573 deaths and 155,000 wounded, out of a total of 340,000 who served overseas.¹⁴

The experience of Australian soldiers at Gallipoli from April to December 1915 was an appalling physical and mental challenge. Nowhere on the tiny beach-head was safe from shell fire and much of it was exposed to snipers. The only respite from the strain of battle came through death, wounding or disease. The difficulties of supply meant that rations were poor and nutritionally inadequate.¹⁵ When the troops were eventually withdrawn from Gallipoli, medical examination found that

practically every man coming out of the Peninsula was neurasthenic, whether he was supposed to be fit or not. Very few could hold their hands out without shaking, and they were all in a condition of profound neurasthenia. The vast majority of the men at that time were suffering from dysentery, and a great number of them had jaundice as well.¹⁶

Conditions were in many ways better in France, where the AIF’s infantry divisions went in the northern spring of 1916. Troops were better fed and units were regularly rotated out of the front line. Most importantly, soldiers were safe when resting behind the lines. But combat for units in the front line was brutal. Australian units spearheaded many major British offensives, suffering fearsome casualties, and even units posted to ‘quiet’ sectors of the front line underwent frequent bombardments and lost men to snipers and trench raids.

Anaesthesia and antisepsis meant that the treatment of war wounds had improved greatly over the 50 years before 1914, and the war prompted further rapid progress, especially in orthopaedic and plastic surgery, and prosthetics. Although infection remained a serious problem, survival rates for wounded soldiers who reached medical aid behind the front were better than for any previous war. The weak spot in the treatment of wounded was retrieving them from the battlefield and bringing them back behind the lines. After disastrous offensives like Fromelles, thousands of wounded were left lying in No-Man’s Land. To retrieve them under fire was dangerous and physically difficult, and many lay where they had fallen until they died from loss of blood, shock or exposure.

The volunteer soldiers of the AIF were as vulnerable to war neuroses as the conscript armies of Europe. Although only 1624 soldiers were officially classified as having ‘shell shock’ in France, 9996 soldiers with psychological disorders were treated by field ambulances, with 7808 being admitted to base hospitals behind the lines for further treatment. Of these, a large majority were categorised as either suffering from ‘psycho-physical exhaustion’ or ‘psycho-neuroses primary-environmental’.¹⁷

Disease was not the devastating threat to most armies in the First World War that it had been in earlier wars, but many Australian soldiers still fell victim to debilitating and sometimes fatal diseases. In Egypt and Gallipoli gastrointestinal infections were common, and Egypt also saw outbreaks of schistosomiasis, scrub typhus and cholera. The most serious disease threat for Australian troops in the Middle East was malaria. From May to December 1918 in Palestine and Syria there were 13,329 confirmed cases of the disease in the Desert Mounted Corps, resulting in 101 Australian deaths.¹⁸ For Australian soldiers in France, the most serious disease was tuberculosis, which was incurable, frequently fatal, and always debilitating.¹⁹ Cerebro-spinal meningitis was another common disease of military camps and troopships, and in the last months of the war and the first months of peace, pneumonic influenza swept through the armies in Europe, killing many soldiers weakened by the stress of war.

Venereal diseases (VD) were widespread among Australian soldiers. Throughout the war, 52,538 Australian soldiers were admitted to hospital with VD, an average of 85 admissions per 1000 per annum.²⁰ Before the introduction of antibiotics, VD was difficult to treat and carried great social stigma. Many soldiers who contracted VD would have carried a heavy burden of guilt and embarrassment, as well as the fear of infecting their wives or girlfriends.²¹

The war-weary diggers who returned to Australia were a far cry from the fit, healthy and enthusiastic soldiers who went to serve King and Country. Over 103,000 returned to Australia as invalids, of whom 31,375 had been wounded and 72,522 were sick or injured. 849 were returned home due to ‘mental problems’. Although buoyed by victory and an enthusiastic welcome home, the returning AIF was a deeply damaged force. A high proportion of the soldiers had been in combat. They had seen unimaginable horrors and undergone experiences brutal beyond belief. Few returned undamaged physically or mentally. The Australian Parliament and people made a commitment that those disabled by their war service would be looked after, but there was little conception of what this commitment would involve. The medical legacies of the First World War would last for the rest of the 20th century and beyond, and the final cost of caring for the war’s veterans far exceeded the total cost of the war. By comparison the annual costs of caring for veterans rose dramatically, from less than £4 million in 1919 to almost £8 million by 1929, and to £9 million by 1939. By the early 1950s, it was £35 million, by the beginning of the Vietnam War, approaching £100 million and by 1982, $1.7 billion annually.²²

From early in the First World War it was accepted that the government should pay compensation to soldiers wounded in battle and to the dependants of those who were killed. In December 1914, the War Pensions Act provided for the payment of pensions ‘upon the death or incapacity of members of the Defence Force of the Commonwealth whose death or incapacity results from their employment in connection with warlike operations.’²³ By 1915, it was clear that the war would be long and costly. As ship-loads of wounded soldiers began arriving home from Gallipoli, it became obvious that post-war care of disabled veterans would require more than just pensions. Various uncoordinated state and private schemes were begun, but soon there was consensus that only the Commonwealth government could fund and manage a repatriation scheme on the scale required.

Speaking at the Premiers’ Conference in Melbourne in December 1916, Prime Minister Billy Hughes justified the generous repatriation scheme: ‘we say to them You go and fight, and when you come back we will look after your welfare. … we have entered into a bargain with the soldier, and we must keep it’.²⁴ But there were other drivers. After the first wave of enthusiasm for the war faded, it became important to reassure potential recruits that they and their families would be looked after in case of death or injury.²⁵ Later in the war, following the Bolshevik revolution in Russia and signs of declining social cohesion in Australia, there was fear of unrest if returned soldiers became radicalised. One quarter of a million trained soldiers were a force to be reckoned with.²⁶

The Australian Soldiers’ Repatriation Bill was introduced into Parliament on 18 July 1917 by Senator Edward Millen, who became the first Minister for Repatriation. He saw repatriation as ‘an expression of the nation’s determination to look after those who, as a result of the war are incapacitated, and to … secure satisfactory reinstatement in civil life of those who are capable of such reinstatement’.²⁷

To manage the repatriation scheme, the government set up a strange dual-headed structure consisting of a Repatriation Commission and a Department of Repatriation (since 1976 the Department of Veterans’ Affairs/DVA) that persists today. The confusion has been increased because the allocation of responsibilities between the two has changed over time. Over the history of the repatriation system, the commission has generally been responsible for the administration of the relevant Acts, including the granting of pensions, allowances and other benefits, the provision of medical treatment and other services and giving advice to the minister on matters relating to the operation of the Acts. The functions of the Repatriation Department have varied more, particularly during the 1920s, but essentially its role has been to provide administrative support for the work of the Repatriation Commission.²⁸

The first Secretary of the Repatriation Department was Nicholas Lockyer, a brilliant and sensitive career public servant, who showed great understanding of the situation of returned soldiers. He emphasised to the department’s officers that they must think first of the needs of the returned service personnel ‘whose interests individually and collectively we must provide for’. He demanded an efficient organisation so that the department was able to ‘render to our returned soldiers the prompt and sympathetic service they are entitled to and which the public expects they should receive’.²⁹

Lockyer was unusually perceptive in seeing that many returning soldiers were suffering from psychological injuries and that these injuries would form a far larger part of the work of the Repatriation Commission than was widely believed in 1918. In April 1918, he wrote to Repatriation Department medical officers: ‘The number of men so affected is very large indeed, and the difficulties of this Department are immensely enhanced by the fact of the general mental upset which characterises so many who find it almost impossible to settle down in any continuous occupation’. He pointed out that the ‘severe hardships and terrific experiences in the trenches’ inevitably caused psychological disturbances which would ‘take some time to subdue’. Further, he was concerned that mentally ill soldiers were ‘in grave danger of … being misunderstood and of their being treated as malingerers’, both by the public and the Repatriation Department.³⁰

On Armistice Day 1918, there were about 170,000 Australian service men and women overseas, primarily in France, Britain and the Middle East. While waiting to embark for home, soldiers were kept occupied with sport, classes and vocational training, but there was still some unrest as naturally they wanted to return as quickly as possible. Restlessness often increased on the voyage to Australia. A.B. ‘Banjo’ Paterson, who had served as commander of the Remount Squadron, wrote of the soldiers on his ship in mid-1919:

The men lie about on the decks all day long and play cards. They have done their share of drill and pack-carrying and trench-digging and watching at night. Now they only want to be left alone … The severe reaction after the strain of war makes everyone sleepy and lethargic. But under it all there is unrest, a look of waiting for something to happen. One sees many faces looking anxious and unsettled.³¹

The members of the AIF arrived home to enthusiastic welcomes around Australia. Large crowds gathered at the wharves to meet the arriving ships and the soldiers either marched or were driven in motorcades through the city streets to the sound of brass bands and the cheers of many spectators. Politicians and other dignitaries gave speeches lauding the returning heroes, and many businesses offered free meals and drinks. The welcomes were repeated at a local level. In Kerang, Victoria, the shire president said:

it was the bounden duty of the people of Kerang and district to show their deep appreciation of the sacrifices which our men had so willingly made … He assured the soldiers of the peoples’ recognition of the gratitude that was due to them. Australia would never forget the debt due to them in days to come.³²

Similar sentiments were echoed around Australia.

It was a massive task to process the large numbers of returning soldiers. On arrival, each soldier’s records were collected, he was medically examined and given an opportunity to declare any existing disability. Fit soldiers were then given their discharge certificates, while those classified as ‘returned invalid’ were kept in the army either until fit for discharge or passed on to the Repatriation Department for treatment. If the invalid soldier’s problems were accepted as being attributed to war service, he would be eligible for a pension. The task was made harder because the medical records of the AIF were destroyed in London in 1919, making attribution of disability a difficult task for most First World War veterans.³³

In the immediate post-war years many expected that the work of repatriation would be largely completed within a few years. Although it was accepted that there would be a long-term commitment to pay pensions and provide medical treatment for the seriously disabled, it was felt that new claims would be rare once soldiers returned to the workforce and resumed normal civilian life.³⁴ This view was reflected during debates leading up to amendments to the Australian Soldiers’ Repatriation Act introduced in 1920. The amended act introduced a special rate pension for blinded and Totally and Permanently Incapacitated (TPI) veterans,³⁵ paid at double the rate of the 100% general rate pension. The minister said that there were about 100 blinded pensioners and believed that the maximum number of TPI pensioners would not exceed 150.³⁶ Although many soldiers had low-level disabilities that might qualify for a small pension, it was believed that their number would decline and that the vast majority of soldiers would never qualify for the TPI pension. This view was based on the assumption that nearly all soldiers would fit easily back into Australian society within a few years.

Consequently, the Repatriation Commission and the government were surprised by the continued flow of new pension claims throughout the 1920s and 1930s.³⁷ There was also a steady increase in the number of veterans receiving medical treatment for war-related problems, from 22,742 in 1926 to 49,157 in 1939, with the largest increases being in pulmonary complaints (mainly related to gas and, probably, smoking), and ‘war neuroses’.³⁸ The reasons for this increase were debated throughout the inter-war years. On one side were the veterans’ organisations, some newspapers, and a minority of doctors, who argued that the increase in claims reflected the inevitable long-term impact of the war on those who fought it. The arduous physical conditions and stress of the war, it was argued, made the war veteran more susceptible to a wide range of ailments. The Returned Sailors and Soldiers Imperial League of Australia (RSSILA) held the view that ‘any serviceman who was passed fit for service and who later developed nervous problems should be entitled to a pension, arguing that the field of neurosis was still vague and, hence, the benefit of the doubt should go to the soldiers’.³⁹ The other side of the debate was dominant in the medical profession and the Repatriation Department. Dr C.A. Courtney, the department’s chief medical officer from 1922 to 1935, commented that in his experience ‘war service had no lasting ill-effects on the general health of soldiers’. Another of the department’s senior medical officers wrote, ‘… the majority of the Department’s clients were not heroes, but plain men and many of them not as much wounded as they wished to be’.⁴⁰ Dr Courtney believed that many of the claims for war-caused disabilities in the 1920s and 1930s were prompted less by ill-health than by the desire for a pension. Pensions, in his view, were demoralising as they ‘fostered a desire to stay ill in the hope of obtaining compensation’. ⁴¹

Generally, politicians avoided taking a position in this debate, scared on the one hand of offending the returned soldiers’ lobby, and on the other of the financial consequences of increasing pension payments. Billy Hughes was a vocal exception. Responding to Courtney’s claim that war service had no lasting harmful effects, Hughes argued that

The statement that in very many cases the effects of the war have not seriously impaired the health, and prematurely aged the soldiers who took part in it, is unsupported by any evidence, and is in conflict with our everyday experience. The suggestion of Dr. Courtney that a comparison of age groups shows that the returned man’s expectancy of life is greater than that of other civilians who did not go to the war cannot be seriously entertained. The facts are that the death rate is based upon the mortality of the whole community, including infants and weaklings, whose expectancy of life is naturally much less than that of the normal individual, while the members of the Australian Imperial Force were a picked body of men, whose physical fitness was superior to that of the community generally, and whose expectancy of life was therefore much greater.⁴²

This is one of the earliest statements of the healthy soldier effect, which is a vital but often neglected factor in analysing the post-war health of Vietnam veterans.

An important, though immeasurable, factor in the difficulties many soldiers had in settling back into civilian life, was nostalgia for the camaraderie, mateship and security of army life. Although war could be arduous, monotonous and terrifying, there was nonetheless a degree of security and solidarity. The soldier was fed and paid and was part of a close-knit group of comrades, bound closely together by their shared experiences. In stark contrast, civilian life was lonely and difficult for many veterans. Soldiers found their friends and families had moved on with their lives and had no understanding of what they had been through. Further, the Australian economy struggled through the 1920s and jobs were scarce. Civilian life was hard for returned soldiers struggling in a competitive job market or battling to survive on a soldier settler’s block.⁴³

The Australian Soldiers’ Repatriation Act gave the Repatriation Commission responsibility for ‘the provision of treatment for disabilities due to or aggravated by war service’. There was little controversy in the inter-war years over the care of veterans who had been wounded or injured during the war. It was relatively easy to assess the disabilities of soldiers who had been blinded, lost limbs or suffered bullet or shrapnel wounds. Generally speaking, these patients received excellent care by the standards of the time.

War-caused or aggravated diseases were more difficult to assess than wounds and injuries. Sir Richard Stawell, the chairman of the Repatriation Commission’s Medical Advisory Board, stated that ‘The fact that the first manifestation of symptoms of disease was noted under service conditions, is taken as equivalent to proof of the disease in question having been caused by service conditions’. However, the destruction of the AIF’s medical records meant that the date of first symptoms was often difficult to establish. The government decided in 1924 that all veterans diagnosed with tuberculosis were eligible for full TPI pensions for life, whether or not it was war-related, but other diseases remained contentious.⁴⁴

In contrast to the generous treatment given to tubercular veterans, the Repatriation Commission steadfastly refused almost all claims for venereal diseases on the basis that it was the soldier’s fault for acquiring the infection. Occasionally individual cases were allowed, usually in cases where the veteran could argue that ‘arduous service might have made the soldier more vulnerable to temptation or prevented proper treatment after infection’. The historians of repatriation admit that there were many ‘arbitrary decisions and injustices’ in relation to VD claims.⁴⁵

A similar assessment could be made of the Repatriation Department’s approach to soldiers suffering psychological injuries. Although Nicholas Lockyer had warned against treating psychologically damaged soldiers as malingerers, there was a strong tendency among the department’s medical officers to do just that. There was an ingrained belief in the medical profession that veterans making claims for war neuroses were either exaggerating their symptoms in their quest for pensions or their mental health problems came from inherent deficiencies or personal and domestic worries rather than war service. These views come out strongly throughout A.G. Butler’s official history of medical services in the First World War. In his opinion, ‘the most important feature of so-called war neurosis … has been that for the most part it is not war and it is commonly not a neurosis in the accepted medical sense, but is a disability of conduct that comes more properly within the field of morale’.⁴⁶ Given these views, it is surprising that there were any successful psychological claims at all. In fact, although doctors at the time were greatly concerned about them, the number of claims was small as a proportion of the number of returned soldiers. In 1931, 13 years after the end of the war, only 13,478 veterans were receiving pensions for mental illnesses.⁴⁷ This was about 5% of living veterans.

Does this mean that First World War soldiers largely escaped psychological damage despite the horrors they endured? The reality is that it is almost impossible to estimate the extent of psychological injury because of the pressure on troubled individuals to suffer in silence rather than seek assistance. The seriously mentally ill were certified insane and locked up, frequently for life, in prison-like lunatic asylums, where treatments were minimal or non-existent. Although lobbying by returned soldiers’ organisations ensured that veterans suffering from war-caused mental illness would not be certified and would be treated in separate facilities from civilians, treatment still offered little hope of cure, and mental illness carried great social stigma.⁴⁸ Further, given the attitude towards war neuroses of most Repatriation Department doctors, there was little encouragement for veterans to make a claim for war-caused psychological injury, so few did so.

The evidence suggests that far more First World War veterans suffered symptoms of what is now called PTSD than ever approached the Repatriation Department seeking assistance. For example, Joseph Whitton had a mental breakdown soon after his discharge from the AIF and was unable to work, but he did not apply for assistance until 1930. His wife wrote to the department,

I have wanted my husband to apply for treatment from your Department but he would not do so. I have had a strenuous time of it these 10 and a half years trying to make ends meet … I had a great job to get him to come in to the Repatriation as he seemed afraid he would be put into hospital.⁴⁹

Many never approached the department at all. Marina Larsson, in her study of the role of families in caring for physically and mentally damaged veterans, gives many examples of families who ‘lived with the distressing symptoms of shell shock on a daily basis’. She tells of households disturbed every night by ‘the nocturnal anguish of returned soldiers’; of soldiers turning to alcohol ‘to ease their mental suffering’; and of veterans whose emotional state led ‘to suicidal or violent situations’.⁵⁰ Similarly, Richard Lindstrom gives numerous anecdotal accounts of restless veterans fleeing to the bush; of husbands who became violent and controlling; of veterans who ‘would remain in one place staring vacantly for hours’; of others who were ‘just irritable, short-tempered’; or of those who were ‘generally depressed, unable to concentrate and fearful of being left alone’. Lindstrom concluded that

The psychiatric legacy of the Great War created veterans unable to adjust to the demands of civilian existence. Restlessness, isolation, alcoholism, violence, divorce, unemployment and vagrancy characterised the lives of many psychological casualties. As a result of their inability to function socially or to work consistently, many of these men became alienated from post-war society and estranged from their families.⁵¹

Many veterans were discouraged from making claims by the adversarial nature of the claims process. Under the original repatriation law, veterans had to prove that their disability arose out of war service. This could be a daunting task given the sceptical attitude of many Repatriation Department doctors and the paucity of medical records from the war years. The department’s own records show that many veterans felt they were treated as criminals or malingerers and that there was ‘an entrenched culture of suspicion in the commission’.⁵²

Some troubled veterans escaped their problems through suicide. Dr S.J. Minogue, in a study of suicide among returned soldiers of the First World War, found that, although the suicide rate for younger veterans was not exceptional, ‘after the age of thirty-five years the risk of their self-destruction becomes greater’ and was substantially higher than for other males of the same age. This was despite the fact that, as Minogue put it, ‘those who served with the first Australian Imperial Force abroad were a picked body of men, more physically fit and more mentally stable than their fellows. The suicide rate amongst them therefore should be theoretically less than that of other males in the same age groups in the community’.⁵³

Dissatisfaction with the Repatriation Commission led the press and veterans’ organisations to push for reforms. A Royal Commission appointed in 1924 failed to address veterans’ complaints, and it was not until 1929 that the government introduced an independent appeals system and made significant changes to the burden of proof provisions.⁵⁴ During the parliamentary debate on the burden of proof, Billy Hughes eloquently made the point,

… to plunge a man into the hell of war for four years, expose him to hardships of