No-one can predict the future with accuracy. Yet doctors in all disciplines are required to make projections about the future and doctors are held to a level of expertise when exercising professional judgement within their scope of practice. The acquisition of expertise requires a knowledge of what expertise is in itself. Diagnosis is such a skill, demonstrating that unstructured professional judgement seldom exists in the absence of semi-structured or structured approaches to expert judgement. Risk has been taken as a paradigm for structured professional judgement. A thorough understanding of the nature of expertise in psychiatry and in the courts is necessary for the practice of forensic psychiatry. The process of both teaching and acquiring clinical expertise is considered both from first principles and in relation to topics such as the use of structured professional judgement instruments and judgement support frameworks. These extend to all aspects of practice including triage and needs assessment, leave, conditional discharge, treatment programme completion, forensic recovery, a range of functional mental capacities, legal defences and reliability.

This chapter examines military attitudes toward “emotional injuries” resulting from the end of romantic relationships. Evaluations of why some men “cracked” evolved substantially from World War I to the present. Often, however, psychiatrists attributed servicemen’s maladies to deficient female love: whether that of mothers or romantic partners. In Vietnam, psychiatrists construed romantic rejection as a “narcissistic injury”: a blow to the ego that led men to decompensate in various ways. Alcoholism, going AWOL, self-harm, and violence directed toward others were all associated with Dear John letters. The chapter considers how the military medical and legal establishments adjudicated unlawful acts perpetrated by servicemen whose intimate relationships had recently been severed by letter. It focuses on two court-martial cases: a Korean War POW who briefly rejected repatriation to the United States in 1953, citing a Dear John as his motive for defection, and a Marine Corps private court-martialled in 1969 for killing four Vietnamese peasants. In the latter case, military lawyers deemed the defendant to have been temporarily insane after his fiancée sent him a Dear John.

Chapter Four, ‘On Leave’, explores tourism in Cairo, Alexandria and London. The chapter begins with the Egyptian cities to explore how the men responded to their expectations of an ‘ancient’ space that was brought to life by its tourist infrastructure: from the perceived ‘sideshow’ of the Middle East, expressions of racism towards the Egyptian people and the clash of ancient and modern. At the same time, though, the men exploited their newfound status as soldiers to access elite spaces and enjoy the cities’ pleasures. The chapter then turns to London. Coming ‘home’ to the metropolis called into question the colonial troops’ relationship to the British Empire – this was not straightforward tourism but had crucial stakes for identity, through better understandings of Britain and their place within it. The chapter concludes by comparing representations of sexual activity while on leave.

Chapter 1 explores the experience of soldiering in the Middle East and Macedonia. Fighting outside the Western Front presented many unique hardships, including fierce combat that could, on occasion, rival the slaughter in France and Flanders, such as at Gaza or Ctesiphon, harsh environmental and climatic conditions, geographic isolation, the threat of insects and tropical diseases such as malaria, and fractured links to home, as mail took much longer to arrive, if it arrived at all, and leave home was rarely granted. The main point of this chapter is twofold. First, in addition to cataloguing the hardships of soldiering in the words of those who fought, this chapter reveals that soldiers in the Middle East and Macedonia constantly, almost obsessively, looked to the Western Front when considering their lot in the war and judging whether they had it ‘soft’ or ‘hard’. Second, by comparing their campaigns to the war on the Western Front, soldiers were trying to prove both to themselves and to those at home that fighting outside the Western Front was not a lesser sacrifice, that they had suffered as much or worse than their comrades on the Western Front, and that they had done their ‘bit’.