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City Research Online City, University of London Institutional Repository Citation: Sturgeon-Clegg, I.S. (2007). Long-term effects of living through both evacuation and the bombing of London during the Second World War as perceived by those who experienced them : A qualitative study. (Unpublished Doctoral thesis, City University London) This is the accepted version of the paper. This version of the publication may differ from the final published version. Permanent repository link: https://openaccess.city.ac.uk/id/eprint/8599/ Link to published version: Copyright: City Research Online aims to make research outputs of City, University of London available to a wider audience. Copyright and Moral Rights remain with the author(s) and/or copyright holders. URLs from City Research Online may be freely distributed and linked to. Reuse: Copies of full items can be used for personal research or study, educational, or not-for-profit purposes without prior permission or charge. Provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. City Research Online: http://openaccess.city.ac.uk/ [email protected] Long-Term Effects of Living Through Both Evacuation and the Bombing of London during the Second World War as Perceived by Those Who Experienced Them: A Qualitative Study By Imogen Sarah Sturgeon-Clegg For Top-up DPsych in Counselling Psychology At City University Department of Psychology And North East London Mental Health Trust Submitted: October 2007 1 CONTENTS Chapter: Page: Dedication 5 Acknowledgements 6 Declaration 7 Overview of Portfolio 8 PART I: Research Thesis 11 Long-Term Effects of Living Through Evacuation and the Bombing of London during the Second World War as Perceived by Those Who Experienced Them: A Qualitative Study Acknowledgement 12 Abstract 13 Chapter 1: Introduction 14 1.1. The East End 14 1.2. The Second World War 17 1.3.1. The Second World War Bombing of Britain and London 18 1.3.2. Evacuation 21 1.4. Psychological Literature of the Second World War 23 1.4.1 Attachment Theory 23 1.4.2 Contemporary Literature Regarding Evacuation and Bombing 25 1.5. Life Review, Reminiscence and Regret 28 1.6. The Long-Term Effects of Evacuation: the Current Literature 32 1.6.1. Post-Traumatic Stress Disorder 32 1.6.2. Trauma in Older People 33 1.6.3. The Long-Term Effects of Evacuation: Current Literature and Research 35 1.7. This Study 40 Chapter 2: Methodology 44 2.1. Epistemological Reflexivity 44 2.2. Researcher Reflexivity 49 2.3. Ethical Approval 51 2.3.1. Ethical Considerations 51 2.4. Participants 53 2.5. Interview 54 2.6. Data Collection Procedures 56 2.7. Data Preparation 56 2 2.8. Data Analysis 57 Chapter 2: Methodology condt Page: 2.8.1. Use of Grounded Theory to Analyse Data in this Study 58 Chapter 3: Analysis 60 3.1. Introduction 60 3.2 Demographic Information 61 3.3. Who I was at the time of the War 62 3.4. Who I could have been 73 3.5. Who I am as a result of the War 78 Chapter 4: Discussion 117 4.1. Explanation of Model 117 4.2. Theoretical Model 118 4.3. Overview of Analysis 119 4.4. Substantive Findings 121 4.5. Relationships to Existing Literature 124 4.6. An Evaluative Appraisal of this Research 131 4.6.1. Recommended Criteria for Evaluation 132 4.6.2. Evaluative Appraisal 133 4.6.3. Further Researcher Reflexivity 135 4.7. Implications for Counselling Psychology 137 4.8. Implications for the World 139 4.9. Implications for Further Research 140 4.10. Conclusion 141 Appendices 142 References and Bibliography 207 PART II: Extended Literature Review 218 The Dissonance between the Medical Model and the Neuropsychological Model: Are Psychological Interventions Appropriate for WW II Veterans? Chapter 1: Introduction 219 1.1. Introduction 219 1.2. Justification for this Paper 219 3 1.3. The Cohort Who Fought in the War 220 1.4. A Brief History of Trauma Therapy 224 Chapter 2: The Dissonance between the Medical and Neurological Model 227 Chapter 3: An Evaluation of Suggested Psychological Interventions for Veterans of WW II suffering from War Trauma 229 3.1. A Cognitive-Behavioural (CBT) Approach (Robbins, 1997) 229 3.2. A Psychoanalytical Approach (Crocq, 1997) 231 3.3. Group Therapy for Older Veteran with PTSD (Snell & Padin-Rivera, 1997) 233 3.4. A Self- Help Approach to War Trauma (Matsakis, 1996) 235 Chapter 4: Conclusion: Recommendations for Working Therapeutically with WW II Veterans 238 References and Bibliography 241 PART III: Client Study 248 Working with Clients with War Trauma who are Avoidant: reflection on a learning process 1.1. Introduction 249 1.2. Brief Biographies of Harry, Alan and Joe 249 1.3. The Neuropsychological Model of PTSD 250 1.4. Avoidance 252 1.5. Psychological Interventions for War Trauma 257 1.5.1 Cognitive-Behavioural Therapy 258 1.6. Working Therapeutically with Avoidance 259 1.6.1. Harry 260 1.6.2. Alan 263 1.6.3. Joe 265 1.7. Conclusion: A Reflection on Learning 267 Appendices 269 References and Bibliography 274 4 DEDICATION This portfolio is dedicated to My Grandparents who served JLK, RAK & CC and Those with whom I worked who inspired me 5 ACKNOWLEDGEMENTS It is with gratitude that I would like to acknowledge the contributions of the following people: Diane Foster, for inspiring the formation of the idea that became the research thesis in this portfolio, Dr Georgina Charlesworth for encouraging my application for funding of the research project and for making it, and the DPsych a reality, Professor Martin Orrell and his team in the North East London Mental Health Trust Research and Development Department for awarding the funding for the research project and for their support throughout, to all the organisations such as Age Concern, the Alzheimers Society, and the many GP’s surgeries I approached who assisted with advertising for participants, to Dr Deborah Rafalin of City University for her supervision, energy, knowledge and support throughout the production of this portfolio, to Julia for her patient typing and to Chris and her colleagues at the Aubrey Keep Library for their assistance and support. I would also like to express my gratitude towards my colleagues, friends and family for their patience, understanding, ideas and views, particularly to Jo, Jan, Elizabeth and Kate for their hospitality when providing places to study. Most especially I would like to express my eternal gratitude to Simon for accompanying me down this long road and for keeping me grounded. 6 DECLARATION1 “I grant powers of discretion to the University Librarian to allow this thesis to be copied in whole or in part without further reference to me. This permission covers only single copies made for study purposes, subject to normal conditions of acknowledgement”. 1 City University Research Studies Handbook 2007/08 7 OVERVIEW OF PORTFOLIO Overall this portfolio is concerned with the psychological effects of War. Specifically it is concerned with the long-term effects of events and actions on civilian children in London during the Second World War (1939-45) and appropriate psychological interventions for veterans suffering from war trauma as a result of both the Second World War and Korean War (1950-1953). The reader of this portfolio will find three papers. The first paper is a research thesis concerned with the long-term effects of experiencing both evacuation (the removal of children and some mothers from cities vulnerable to enemy bombing to areas in the countryside considered to be safer) and the bombing of London during the Second World War (1939-45). This study is unique in its field. Previous research studies (e.g. Foster, Davies & Steele 2003) have used quantitative methods such as postal questionnaire surveys to explore the long-term effects of evacuation alone. The study in this thesis used one-to-one, face-to-face interviews where participants were asked in an open manner what they consider to be the long-term effects of both these experiences. Grounded Theory (Glaser & Strauss 1967) methodology was used to analyse the resulting data. The resulting multi-dimensional concepts and model that emerged echoed the existing literature broadly concerning attachment e.g. Bowlby 1940; A.Freud in Bridgeland 1971), identity (e.g. Breakwell 1986), trauma (e.g. Hunt 1997) life review (e.g. Garland & Garland 2001) and, of course both the contemporary and current literature regarding the long-term effects of evacuation and other wartime events (e.g. Bowlby 1940; Foster et al. 2003). However it also, most importantly, introduced several new and significant ideas relating to the effect of these wartime experiences on the formation and development of identity and physical and psychological survival. The second paper addresses the appropriateness of the psychological interventions currently available for veterans of the Second World War suffering from war-related trauma, with an identified dissonance between the medical and neuropsychological models (e.g. van der Kolk, McFarlane & Weisaeth 1996) in mind. The identification of this dissonance has occurred both through an exploration of the literature concerning the experiences, beliefs and attitudes of the cohort of people who served in the Armed Forces during the Second World War and by the author who works therapeutically with members of this cohort. It is asserted by the author that those members of the cohort who formulate their difficulties within the medical model may experience difficulties engaging with ideas and interventions that reside 8 within the neuropsychological model of post-traumatic stress disorder and, specifically, war- trauma.