Three of the seven VIs sustained physical injuries, one form of which (blast injury) is described: ‘I was an engineer dealing with demolitions – keeping roads open, providing water supply to 6000 troops. Infantry go past us then we were left in front - if Chinese about we’d blow up a bridge. I was blown up and crushed. They’d put up artificial moonlight too early - suddenly a loud explosion behind me - a 2 1/2-ton truck blown up behind or alongside me. I went to MASH - to ship - then Kurari and there to convalescent depot. Then hotel - then sent me back on hospital ship.’ (Regular non-combatant). In the following comment, the POW describes the injuries to his eye and leg from shrapnel having been shot prior to capture: ‘Chinese wanted to have a go at this [eye] but I wouldn’t let them - 3 to 4 pieces of shrapnel in this one - a delicate piece of mechanism. Didn’t want anything to go wrong. This one [leg]- Below knee – they did suture. [Where and when did surgery on leg and eye take place?] Roehampton Hospital – did eye year I came home. Two years later lost the battle with this one – once established on this [prosthesis] never looked back. [When a POW, could you stand?] On leg tried to - Yes I could stand on it but lump of dead meat really.’ (Regular, combatant, POW). A further VI developed a medical condition which he related to the conditions in the KW: I had arthritis in my feet when I was working after the KW. I used to blame Korea for that – the terrible cold winter - we were in tents of all things. I still get the odd twinge but nothing like I did when I was working. (Regular, non-combatant). In the first comment related to early onset mental health problems, resilience enabled a positive outcome for one VI who focused upon his University studies as a form of mental therapy to combat nightmares and loneliness: ‘I got most of my problems within 5 years of leaving the service. When I came back had to restart and go to Uni. where I soon discovered I was 200 years older than everyone else - not in age but in mentality. There were lots of spotty-nosed kids there that I couldn’t share anything with. I was extremely lonely… had a lot of nightmares but just concentrated on studies. It might have been part of the therapy!’ (Regular, Reservist, combatant), The same VI claimed that being able to talk about his experiences was therapeutic and having been able to overcome such adversity, he approached post war civilian life with enthusiasm: Yes, I did have quite a lot of nightmares. But I am amazed they have gone. I have never had regrets. Time helped but I don’t know if I am built that way. I can talk about almost anything – no everything. Life became exciting as I got different jobs. All this was almost exciting - I found it was replacing parts of my memory if you like (Regular, combatant). A further VI arranged a display of his memorabilia before the interview but when he started to talk about them, he began to show signs of distress and the more he tried to avoid further distressing thoughts the more upset he became: Something you said just triggered it - I have overcome that’. [Veteran doesn’t say what and is visibly upset]. [Wife joined conversation.] ‘He always gets emotional don’t worry about it. He has sleepless nights …. you should have asked me about them…he doesn’t remember them though.’ ‘I can tell when he’s going to have one of these nightmares – by his breathing.’ Wife of National Serviceman, combatant). The veteran tried to regain his composure but when talking about war casualties, he became distressed again and the interview was discontinued: ‘One thing that did effect you - you heard of casualties and that - you don’t want to go home limbless. I would have hated that. That was then…. [Interview stopped due to visible distress. Welfare Officer of BKVA alerted to make early contact].

The extreme cold suffered from the severe winter climate (particularly in the early years of the war) is described below for which both British combatants and non-combatants were militarily unprotected in terms of the lightweight uniforms they were issued with: ‘Weather – complete shock. The temperature first night 20 below freezing and lowest 40. On coldest nights, 3 of us on small bridge. One was supposed to be on guard but only one thing to do - we huddled together. Still managed a sense of humor.’ (National Serviceman, combatant 1951), ‘Arrived in December 50 – worst winter 48 degrees of frost tremendous probs with transport ‘cos diesel froze. They used to light fires underneath the vehicles to warm ‘em up! Food wasn’t brilliant either. (Regular, combatant), ‘The enemy was predictable - you accepted you know what was likely to happen but none of the training prepared us for the weather. (Regular, combatant, POW) In conjunction with the cold weather, appalling living conditions were described by the VIs in the early part of the war in particular, that added to the misery of the various war zones and these memories are still remembered today as sources of distress both then and now: ‘We were living – below, above ground, on mud floors, anywhere depending where you were. If you had four walls and a roof over head, you had struck lucky!’ (Regular, combatant, POW).
‘The squalor, dirt, conditions – the whole place a cesspit - human excreta ladled onto fields - Korean practice in those days. No surface water, reliant on artesian wells put into water trucks. It was filth - smell indescribable - rats everywhere. National servicemen not used to be away from home - some got homesick – a lot of belly aching.’ (Regular, Reservist combatant). ‘Problems basically were living conditions were so bad - the dirt – the flies. Every time the tea was made there were about 50 flies – we’d scrape them off and drink it. Dysentery? Yes! Was rife. Improved the 2 years when things were static – then there was organized sanitation - proper huts. (National serviceman, non-combatant). A few VIs’ recalled events as sources of distressing memories. The witnessing of the harsh treatment of the displaced Korean civilian population was described. The VI’s feeling then and now of helplessness as a witness unable to prevent or change what was happening remains a continuing painful intrusive memory that could be perceived as a ‘moral injury’. In this comment, the VI still had not shared his memory with his wife: ‘There are certain things (story of US troops rape of a young civilian Korean girl)- little things I am ashamed to have had to witness. I don’t feel guilty about it but I could do nothing about it. I haven’t even told [wife] this…. That young girl - I felt I couldn’t believe human nature could do that sort of thing – in that state. I can still see this girl’s face.’ ‘I have never even told my wife about this.’ (Regular, Combatant). In another comment, one event triggered the painful memory of another from the past: ‘After we married A wanted a paraffin heater – I said “no never” - I have seen the results of Napalm. In this village I can see him now, obviously survived but did not escape it. Face and hands covered with paraffin gauze – the living dead. This doesn’t keep me awake either, but Napalm is .... ‘(Regular, combatant, POW).
The reservist combatant VI provide testimony related to the emergence of distress symptoms in others and draws attention to stress not being just confined to combatants but also noncombatants who shared the same conditions if consigned to work in the war zones: ‘There are some, if you think back, some things if you think about it. I guess there is a different stress level relative to action, the guys that fire bullets have some stress but so did others down chain. It’s wrong to concentrate on front line. (Regular, Reservist, comnbatant). The secretive hiding from others the distress from memories is evident in the following comment:
‘They are carrying a lot of weight – what they don’t want to tell, what they should have done and didn’t do at some time.’ (Regular, non-combatant). The feelings of loss and sadness for known and unknown comrades who died in Korea remained high on the minds of all the VIs, as illustrated in the first comment.
The chap I think about every day [GB] he was killed coming across a ford…. last words to the driver was that he was too slow to make a cup of tea. Right on top of the bank and he caught full blast…. Colonel saw what happened …. I know for a fact he cried too – only his boots were in his grave.’ (National Serviceman, combatant). However, combatants tended to have the additional concern of having to leave a body behind where it fell and the anxiety and guilt of not knowing what had happened to it: ‘So he died there. [What happened to him?] I’m ashamed to say, I don’t know. I don’t know if he was buried but this is something. This is about the only thing I – well I don’t lose sleep over it. It’s the thing that bothered all of us and we can’t forget it. Life is like a piece of string – you remember the knots - this is a boulder! The fact that we were not able to bury our dead. We had to leave them where they fell.’ (Regular, combatant). Non-combatants also felt the loss of friends keenly: ‘Certain things always with me. I lost one dear friend -rarely a day when I don’t think of him. And, others….’ (National serviceman, non-combatant).

Only a few of the VIs were married during the war but after it, their wives became a major source of support across their lives: ‘I just get on with it. Life is great. M must dress me. Just make most of what you’ve got.’ (Regular non-combatant - blast wounds). ‘She comes down on odd occasion. I think the BKVA would struggle without the wives - great contribution.’ (National serviceman, combatant). ‘my wife, God Bless her, was ideal partner - she shared the odd nightmares. She says, “And what was that all about?” So, I’d tell her.’ (National serviceman, non-combatant). ‘…. Alright I’m lucky I landed on the right side and I met my wife A’. She was a sister on the ward at Roehampton and she would say “S. get up out of that bed.” (Regular, combatant, POW).

Only the regulars described the military in terms of professional values with emphasis upon ‘the stiff upper lip’ and clarity of professional roles and purpose: Morale remained good right up on that last hill – but then that’s British troops. It’s mixture of ingredients - military training, family background, upbringing. Yes, I suppose ‘stiff upper lip’. Col B, for example – during the battle, B said ‘not too bad, a bit sticky’, - what he really meant was ‘all hell’s broken loose and I’m right up the shute!’. You wouldn’t allow yourself to say that. (Regular combatant, POW). ‘I had achieved travel and adventure, perhaps a bit further up scale than I had bargained for, but nonetheless I had joined the Army to have adventures. I was trained – trained to kill, trained to fight. Yes, I had hoped to put my training into practice – that’s what you do. I’ve never felt bitterness. That’s what we do. Um. I accepted it all. ‘(Regular, Reservist, combatant). In the following comment, a regular Reservist combatant describes the shock he felt when he found national servicemen were ignorant of the reasons for the war and why they were in Korea. I am one of the few who served in both Malaya and Korea. 51`-52. At least I knew what I was doing - what the war was about. Most of replacements from Japan didn’t know what they were there for. Some knew they were going to fight the Chinese but what for? This horrified me that young national servicemen were going there but no idea what for. One or two of them I chewed this over with after it were still laissez faire about it. They saw it as just doing what had to be done.’ (Regular Reservist Combatant).
A further comment reveals the ignorance of national servicemen and the attitude of the military towards them as just ‘boots on the ground’. ‘Not really aware of politics at time only later read what could have gone on. Just concentrated on what we were doing…. we were just numbers. If you had done basic training, you went into combat.’ (National serviceman, combatant).
Comradeship supported by a continuation of military cultural values and humour enables the BKVA veteran members to talk about the war as a shared experience, even though the latter was diverse. If not members of the BKVA, some members would be isolated at home and social sharing would be lost: ‘One or two of us swap war stories but not much of that. If it is, it’s always on the amusing side. We tend not to talk about brutal aspects. We can talk about arms, legs, and bits all over the place but that’s rare. I don’t find any embarrassment about it.’ ‘Comradeship – we’ve shared an experience but not a common experience. Recognition that there was a lot of sacrifice and it shouldn’t just disappear out of the history books. It was significant at time, but it is still a divided country. We talk not about Korea but about what is happening today. We do share common values. For some Korean vets their only outside contact is with the organisation.National Servicemen keener on Korean Vets (BKVA) than regulars. For them it was the most significant time in their lives - when they talk, they still feel as if it was yesterday. (Regular, combatant). The further comment below adds verification to the key finding from the survey, that combatants and non-combatants both shared and suffered from the hardship of the conditions they endured: Well, largely comradeship - we’ve all, whether we have fired a shot in anger, or sat down at Pusan, we’ve all experienced the country and the hardship. (National Serviceman, non-combatant).

The act of remembrance was strongly supported as part of being a member of the BKVA by the VIs at both a macro and a micro level. The macro level was linked to the VIs’ perceptions of themselves as the guardians of the collective memory of the KW for a society that the VIs perceived as being uninterested and ignorant, both at the time of their return home and in the present day. This comment suggests that the VIs leave much unsaid about the causes, effects and extent of their disturbed ‘peace of mind’ but he does suggest that the creation and unveiling of a memorial provides a degree of closure: The memorial helps - but not Jo Public particularly. Jo Public is either interested because they knew someone there, or as a historian, but otherwise Jo Public has never been particularly interested. But I think it is useful. It helps lay something to rest by the construction and unveiling. We do it for our own and our comrades’ peace of mind.’ (National serviceman, combatant). Recognition of service and sacrifice are the clearly evident in this second poignant comment: ‘Do you know, I couldn’t sing the second verse of the National Anthem. If I’d tried, I would have broken down. I remember afterwards after the service - sort of - I suppose I looked up, and I remember thinking to myself - I didn’t say anything - I just thought, “You thought we’d forgotten you but we haven’t, we haven’t… your now properly remembered, and will be marked for all time.” (Regular, combatant, POW with reference to the unveiling of the memorial in the National Arboretum, Stafford, England 2000 in remembrance of those who lost their lives in the Korean War).

Perceptions of a mental health ‘burden’ from the VIs’ memories of war-time experiences comprise a range of responses. This first comment made by a wife half-way through the interview when the VI had left the room suggests that behind his interview responses, he was hiding a greater truth concerning the cumulative effect of grief upon his mental health due to loss if siblings in WW11 and then having served in Korea: ‘He lost 2 brothers in the War then he went to Korea. I think you don’t know the half of it -’ (Wife of National Serviceman, combatant). However, for other VIs, the size of the burden created by distressing memories appears to be mediated the resilience and personality of the person: ‘Some can handle things, some can’t, some get emotional, some don’t.’ (Regular, combatant). In the next comment, the burden of distressing memories is described as an essential part of the person and suggests that despite damage to mental health, it has a protective role by giving meaning to the VIs’ lives. It also draws attention to the life-long effects from service in Korea, some of which can have late-life onset: ‘Almost to encase themselves - a protection - in fact if there were a way to remove them it might be counter-productive. Remember the knots? For some, they loom large even 50 years later but at the same time in some cases, knots can appear on piece of string where they were not there before, and other knots can become larger.’ (Regular, combatant, POW). As with the above comment, a further comment suggests that the burden is an accepted and integral part of the veteran’s life: ‘I just let it be – it’s all part of life’s rich tapestry.’ (Regular, combatant). Indeed, in this final comment, the VI questions if distressing memories were to be removed what could take their place:‘If they [distressing memories] were removed what would we replace them with?’ (National Service man, combatant). The above comments could suggest that distressing memories appear to have been accepted as a ‘willing’ rather than an ‘unwilling’ burden that if removed, would leave a void that could not be filled. Finally, although combatants provided more life gains than losses from the war in the survey, beyond their resilience in adversity and comradeship the following comment suggests that with time, valuing life has become more important than glorifying war: Some may say why put up granite plinths - to the glory of war. It is not to the glory of war, there is no glory in war, there is no glory in war - I know, I’ve been there.’ (Regular, combatant, POW).

In this qualitative part of the larger study, seven themes with their related sub-themes were identified from the transcripts and tapes through thematic content analysis. These support the growing adherence by researchers to a multi-dimensional approach towards participation in warfare and its relationship with life span [8,10,17]. Furthermore, the themes with their sub-themes add detail and greater insight to the recently published survey results for losses and gains [4]. Several authors agree that those who have confronted heavy exposure to combat are those at greatest risk of emotional and behavioral problems in their post-war years [6,10,11,16,17] but in mid-life, other authors suggest that they can gain life benefits from military experience [31]. For example, those who had faced heavy combat were shown clinically to have become more resilient and less helpless over time in comparison with other men [31]. All of the 4 regular VIs of whom 2 were combatants were successful in terms of their post war education and work-life. Thus, consistent with the survey’s, combatants material life gains outweighed losses following their participation in the KW, but this could have been the result of bias in the BKVA’s selection of these participants. All but one of the combatants had vivid recall of particular events, some of which they found difficult to talk about and of these, some tended not to share them with their spouses. It needs to be remembered that the VIs grew up at a time when the culture both military and societal tended not to disclose information that could make them look psychologically weak [31].

Two VIs had physical disabilities sustained during the KW and one had a medical condition. Of the 7 veterans, one reservist regular VI recognised the vulnerability of non-combatants to stress, a key finding of the related survey [4]. Several authors and most of the VIs suggest that the personal qualities brought to the KW in terms of hardiness, resilience and coping learned during their austere childhoods in WW11, stood them in good stead against the stressors of the war and in its aftermath [6]. Furthermore, although childhood adversity is a precedent for negative life span outcomes such as episodic depression and anxiety, if this is overcome (as in the account given by the Regular Reservist), it is more likely to produce positive life outcomes [6]. Certainly, he believed that his University studies cured his nightmares and loneliness freeing him to face life’s opportunities with enthusiasm.

The VIs combatants’ main recall of war-time memories was of killing or seeing others killed and the personal fear that they felt. These memories were initially presented by them in a nonemotional matter-of-fact way, but as the interviews unfolded, it was evident that underlying this understatement, they held a profound sadness over the deaths of comrades that they had witnessed or where they were uncertain as to whether or not a particular body had been recovered for reburial. In the VI Reservist combatant’s comment, he describes the numbing effect resulting from his traumatic WW11 upbringing upon his life-span bereavements. This inability to show grief is commonly associated with PTSD [32] and is linked to survivor guilt [33]. A further VI in recounting the memory of a young refugee rape victim suggests that there is the potential in these circumstances for ‘moral injury’ [34,35], as there was nothing he could do to help her beyond his witnessing the event. According to Litz et al [35], this condition occurs when there is “a failure to prevent, bearing witness to, or learn about acts that transgress deeply held moral beliefs and expectations” [35]. It is of note that both moral injury and survivor guilt have attracted little research to date, even though the respective authors stress that these conditions are common [33,35].

Of the four combatant VIs, one combatant national serviceman was visibly suffering from distress at the time of interview. He had gone to great lengths to lay out his memorabilia from the war, which in the event proved too difficult for him to discuss due to them triggering intrusive distressing memories and his inability to avoid them. Three other VIs said they had poor mental health after their return home from the war. Although none of the noncombatants showed signs of psychological symptoms at the time of interview, two mentioned their intrusive memories of the physical suffering, e.g. frostbite, caused by the extreme cold that they and all United Nations troops endured and as reported for US troops by a contemporary author [36]. During the war, comradeship and shared humor were important as a means of promoting group cohesion, and fifty years after the war both are still held as valuable resources for discussing war experiences and the emotional content of traumatic recollections [37]. More often, the VIs’ form of current comradeship within the BKVA is spending time with those who have shared values (mostly influenced by the military culture).

The VIs were united in their role as guardians of the memories of the War and the troops who did not come home. Their motivation lies in the strong desire that future generations would no longer see the Korean War as the ‘forgotten war’ but one fought with resilience and pride. However, the VIs showed their strong disapproval of post-war or current counselling with the suggestion that it weakens resilience. This prejudice may have more to with the VIs sense of a willing acceptance of the burden of painful memories as one that that should not be revealed or delved into by outsiders including professionals. The act of remembrance given by the VIs as survivors provides a meaningful outlet for communal grief and the construction and the unveiling of a monument to the KW was a means of providing some degree of closure, at least for the concept of a ‘Forgotten War’.

The researcher was aware of the possibility that the responses of the VIs could reflect an exaggeration of the reality of war-time events [38] although it is possible that those with PTSD-type symptoms could have better recall than those who do not have symptoms [39]. Identifying when the truth has been altered or not is almost impossible in a survey of this kind and so long after this War as an event. What was helpful to the ‘believability’ of the VIs’ accounts of psychological symptoms were the spontaneous verifications of the VIs testimonies by their spouses in 3 of the 7 interviews.

The findings shed light upon the mental health of older KW veterans living in the community some of whom are experiencing distressing memories with the potential to damage their psychological health and quality of life. Combatants predominantly related their memories to issues of combat exposure but both combatants and non-combatants (to a lesser extent) had distressing memories of the freezing Korean climate in winter, the filthy environment and living conditions, the loss of friends and the observed plight of refugees. Their accounts of the effects of the KW upon their present lives indicate that despite the presence of intrusive memories (or ones that they tried to avoid) none were keen to lessen the burden and in particular all wanted to avoid the involvement of counsellors. Instead, there was evidence of a willingness to keep this burden because they perceive it as keeping alive the War’s history and the memory of those who died in it.
The hardiness and resilience gained from WWII as children, would seem to set the British KW veterans apart from those of wars that preceded the KW and those that came after it. A strong adherence to the military cultural trait of putting on a brave face against adversity and despite physical injuries and mental health damage, appears to have an enduring role that both protects and nurtures the strong bonds of comradeship between them within their veteran association.

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