Serving in a bomber crew was a high-risk occupation. Bomber Command losses over the course of the war amounted to 55,000 out of 125,000, a death rate of nearly one man in two, most of them young. Anyone over 25 was likely to be known as 'Grandad'.

With the constant risk of death and continual loss of friends and comrades, bomber crews worked in unimaginably stressful conditions, as well as suffering intense physical and psychological fatigue from tours of duty lasting 30 or 40 raids. Most responded by suppressing the symptoms of stress. Squadron medical officers supplied sleeping pills when needed, supplemented by amphetamines to wake the men up in the morning.

Men requesting a transfer out of Bomber Command after a full complement of missions, or an unusually harrowing experience, were handled considerately by commanding officers. Outright refusal to fly was treated severely. The offender was branded as a coward with the official diagnosis of 'LMF' (Lacking Moral Fibre), and transferred to menial duties or discharged. The 'LMF' diagnosis was widely resented by crewmen, who felt that the 'brass' were making light of terrors which they never had to face. Whatever the psychological condition of an individual, Bomber Command prioritised the requirements of the squadron as a whole, and thought that allowing cowardice to go unpunished would encourage others to let their terrors get the better of them.

The condition labelled 'LMF' had been known as 'shell shock' in World War I; 'combat fatigue' or 'battle stress' in the Vietnam War. Today, those airmen would be diagnosed as suffering from post-traumatic stress disorder (PTSD), a medical diagnosis introduced in 1980, and given clinical treatment. Although sufferers from PTSD and similar psychological problems are still informally stigmatised among members of the services, these conditions have been recognised as a medical syndrome requiring treatment. Service-related illness continues to be controversial, however, and victims of 'Gulf War syndrome' are still campaigning for official recognition of their condition.

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Lancaster bomber in flight