Abstract
The combat and operational stress can push a soldier to his outermost limits. Negative reactions to such stress include an agitated mood or moodiness, anxiety, and panic attacks, a feeling of pressure, hypervigilance, sleeplessness, troubling memories, rage outbursts, a feeling of shock and numbness, thoughts about the people who died and suffered, constantly feeling guilty about someone’s death, drug abuse and alcohol abuse, sadness, and rage. Anxiety and depression are the most common symptoms. The extent or level of these reactions depends on the individual. One individual might react to combat and operational stress by an increase in the reaction time. Soldiers as young as 31 years and as old as 48 years suffer from combat stress. Physical symptoms include sweating of hands, trembling, and an increase in the heart rate. In many cases, the individual need to go to the washroom increases. Physical symptoms also include headaches and chest pains due to anxiety attacks. Even though it is the duty of the government and the team leaders to ensure that they help individuals to avoid and overcome stress, but it is the duty of the individuals too, to make sure that if they notice a change in their behavior, they try stress-reducing techniques and instead of denying it, work to make it better.
Introduction
Stress is a way someone reacts to a particular type of situation or event. This situation and events sometimes pressure the individual to behave inappropriately. (Lyness, 2007) Combat and operational stress (COS) is emotional and physiological stress which is a direct result of dangers faced in combat or the mere tension of being in combat (Army Medicine, 2008). These are invisible effects of war. If the stress of combat is too intense and prolongs for a longer period of time, it affects the individual’s ability to handle stress and pressure. Many people do not believe that any such thing exists; the reason for this is the inability to see the physical changes due to combat and operational stress. These changes are behavioral changes that are usually noted by the family members or people close to the individual under stress. However, it should be noted that COS is not a weakness, and much strong personnel cannot handle stress and eventually react. (Dombro, 2007).
“Combat impacts every Soldier mentally and emotionally… and often leads to lasting adverse effects…. Combat stress reactions should be viewed as combat injuries”. (Walter Reed Army Institute of Research, 2006).
It was in World War I when the soldiers started showing signs of combat stress. The symptoms included sleeplessness, amnesia, depression, and anxiety. It was then believed that only women were supposed to have psychological illnesses, and men were stronger. They did not have any psychological illnesses. (B. Shephard, 1996). It was concluded that due to high explosive shells which came down the soldiers, these soldiers went into a ‘shell shock.’ (Babington, 1997). In World War II, care was taken to reduce the number of people under combat stress. Almost $42 million was paid to war veterans during the first world war. (Shephard, n.d). In the Second World War, almost 1,600,000 soldiers were not allowed to serve in the military. Most of these soldiers had psychological problems. The table below shows the number of people who had combat stress in the Second World War. It should be noted that these are the numbers of soldiers who got combat stress.
Table: Number of US soldiers from Jan 1 to May 15, 1945.
Currently, almost 200,000 vets are being treated in Britain for Combat stress. In the United States, almost 38% of the total soldiers admitted had mental disorders.
Symptoms
It is normal to be a little stressed in the warzone. However, if the level and time period of this stress increase, it causes physiological harm. It is not the individual fault, nor is it any kind of weakness. However, this kind of combat and operational stress injuries take time to heal.
There are various symptoms of combat and operational stress, and these vary from individual to individual. All of these symptoms are a general response to any kind of stress, and depending on the stress level, can last for a few days or sometimes even weeks. However, sometimes these symptoms last for a very long period of time, and the intensity of these symptoms then starts affecting the day-to-day activities of the individual. In such cases, usually, professional help is required in order to calm the situation. (Dombro, 2007).
When the soldier, who suffers from such ailment, returns from the war zone, it is the family who usually notices a change in the behavior. This change in the behavior is not only due to the combat or the operational stress of the war, but sometimes it is also due to the handling of the remains of the war. Witnessing the destroyed villages and cities, dead people, and depressed civilians, etc., also leads to combat and operational stress. According to an army doctor, Elspeth Cameron Ritchie;
“Combat stress reactions, which are psychological reactions to fierce combat or operations other than war, are both physical and psychological “(Regulatory Intelligence Data, 2003).
Physical symptoms include sweating of hands, trembling, and an increase in the heart rate. In many cases, the individual need to go to the washroom increases. Physical symptoms also include headaches and chest pains due to anxiety attacks. Some people also notice a trigger in allergic reactions such as asthma and eczema due to an increase in the stress level. These physical symptoms are noticeable; however, it is usually difficult to notice the psychological change unless you know the person well. The psychological symptoms include anxiety and panic attacks, sleeplessness, an increase in irritability and eating or drinking too much, etc. (Lyness, 2007). The extent or level of these reactions depends on the individual. One individual might react to combat and operational stress by an increase in the reaction time. The ability of that person to think about a situation and react accordingly slows down. Operational stress also leads to difficulty in managing even day-to-day tasks. These daily routine tasks are hindered due to fatigue or anxiety. Individuals lose the ability to concentrate on anything and keep on thinking about the factor responsible for their changed behavior. This triggers the stress level even more and hence deteriorating the psychological condition of the patient. It is natural for these individuals to keep their feelings to themselves and not discuss them openly. However, immediate professional help should be asked as these conditions and symptoms deteriorate over the passage of time. According to Ritchie, who is a psychiatrist, when these symptoms become a hurdle in day to day activities of the individual, it is time to seek professional help. (Regulatory Intelligence Data, 2003) For example, in combat, the reaction time of a soldier is very important; if the reaction time increases or there is a delayed reaction to certain events, the others soldiers should notice this and report accordingly. Below is a list of various physical and psychological symptoms of combat and operational stress; however, this list does not contain all the symptoms which can be noticed, neither noticing these symptoms can help a person point who has combat stress. These are just general stress symptoms that can be related to other kinds of stresses too.
Physical symptoms: These include shortness of breath, dizziness, heavy heart (or the feeling of something heavy on the chest), accelerated pulse, increase in blood pressure, digestive problems (such as nausea, vomiting, diarrhea, loss of appetite, or a sudden increase in the appetite, increase in the bowel movement or frequent urination, etc.), cramps, backaches, headaches, weakness and paralysis, impaired speech or muteness and problems in the vision. Allergic reactions such as eczema and asthma are also a result of combat and operational stress.
Psychological symptoms: These include an agitated mood or moodiness, anxiety, and panic attacks, a feeling of pressure, hypervigilance, sleeplessness, troubling memories, rage outbursts, a feeling of shock and numbness, thoughts about the people who died and suffered, constantly feeling guilty about someone’s death, drug abuse and alcohol abuse, sadness and rage, hallucinations and delusions, feeling of weakness, loss of skills, loss of memory, terror and panic, freezing and inability to move, erratic reactions, depression, insomnia, loss of confidence, loss of hope and faith, inattention and carelessness. (Singleton, 2006).
These symptoms of stress are usually noticeable to the families after the person comes back from the war. During combat, the result of such stress can often lead to criminal acts too. These include:
- Mutilating the dead
- Killing all the enemy prisoners
- Killing the civilians who are not taking part in the combat
- Torturing the prisoners brutally
- Killing the animals present in the war zone
- Fighting with their own friends and the allies
- Abuse of drugs and alcohol
- Looting the villages and raping women
- Formation of fraternities
- The feeling of being sick and therefore excessive sick leave
- Negligence in case of any injury or disease
- Avoidance of work and malingering
- Refusal to be in a war or combat
- Inflicting oneself with wounds
- Suicidal behavior or threatening to kill own self
- Becoming absent without prior notice
All of these symptoms are a direct result of combat and operational stress. When these symptoms or behavioral changes remain present for a long period of time, they become more severe and hence destabilize the personality of the person even more. Painful memories and constant thoughts about these memories are one of the long-term effects which have an impact on the individual. Social isolation and alienation are yet other long-term symptoms of combat-related stress. Depression is probably the most common form of combat stress symptoms. (Headquarters, Department of the Army, 2006).
The symptoms discussed above are the ones that adversely affect either the individual or the people around him. However, there are some e stresses which cause adaptive reactions which actually have a very positive outcome. These produce loyalty among the soldiers, cohesiveness, and loyalty to their peers. The sense of elite mentality, which is a result of this kind of stress, produces in the individual the strength to bear more hardships (such as discomfort, pain, and injury) and the ability to perform heroic acts. All of these symptoms have let the military leaders get utterly confused. The main thing for any leader is to know his soldiers. If the behavior of that soldier is out of the norm, the leader should be able to recognize it at once. (Kennedy, & Zillmer, 2006)
Stressors
Stressors usually trigger the stress level in an individual. There are two types of physical stressors (environmental and physiological) and mental (cognitive and emotional) stressors. The various reasons for the increase in the stress level are given below.
Physical stressors
Physical stressors include two types of stressors, environmental and physiological. Both of these are a result of the direct contact of the ailed individual with the environment.
Environmental factors: heat, cold, wetness, dust, noise due to blast or any other reason, vibration or movement, weapons, bombs and other directive devices, radiation, infective things, any kind of tiring physical work, poor visibility of objects due to darkness or haze, etc., difficulty in movement due to arduous terrain, high altitude, etc. all these physical factors usually trigger the already stressed-out person. For a normal person, these conditions might able a part of the day-to-day routine. But for an individual who is psychologically ill and is still present in the combat zone, these physical conditions might arise again and again, and it might become difficult for the individual to accept them, and hence he might become more agitated, or an increase in the intensity of the symptoms might be noticed. (Headquarters, Department of the Army, 2006).
Physiological factors: Physiological factors include factors such as sleep deprivation (this might be due to an increase in the duty timings etc.), dehydration (as it is difficult to control the factors in a war), malnutrition, poor hygiene, muscular fatigue, which can be a direct result of the overuse or underuse of a person’s muscles, illness or injury, sexual frustration, substance abusive problems, poor physical conditions, and aerobic fatigue, etc. Usually, the conditions in a war cannot be controlled, and hence it is difficult to manage these stressors. These stressors then stress out the person who is already not in a good psychological condition. (Headquarters, Department of the Army, 2006).
Mental stressors
There are two types of mental stressors two; these include cognitive and emotional stressors.
Cognitive factors: cognitive stressors include too much or too little information, sensory overload or deprivation, uncertainty and ambiguity, the pressure of waiting (problems due to time), difficult decisions (if the person has a decision making role in the combat zone and the lives of several people depends on what he decides to do, sometimes the reason for winning and losing a war might also depend on how well he places his troops), changes in the organization (cultural and hierarchical), impaired functioning, workload beyond the individual’s abilities and skills and previous failures (which might result in the individual to believe that he will fail this time also). These factors are usually controllable if the individual is not in a very bad psychological condition. However, as mentioned earlier, it is difficult to manage things in a war zone, and people usually have to do work beyond their skill level and physical attributes. (Headquarters, Department of the Army, 2006).
Emotional factors: being in a new unit or being isolated from other friends and peers, fear of dying in the combat or being a prisoner, anxiety due to war threat or injury, etc., losses such as the death of peers or leaders, anger and frustration due to guilt or resentment, inactivity which produces boredom and makes the individual think a lot, conflicts and different motives in the team members, interpersonal conflicts due to other reasons, loss of privacy, witnessing dead bodies or destroyed homes and families, victimization or harassment and home worries are the emotional factors which lead to combat-related stress. (Headquarters, Department of the Army, 2006).
At this point, it should be noted that these stressors, if combined with good leadership and peer support, can lead to an individual being rather helpful to the troop. Personal trust and loyalty between eh leaders are the sole cause of adaptive stress reactions. The cohesive force which keeps the troops and the unit together also acts as a positive stressor. It helps the individual get courage and show acts of heroism that could not have been shown by him otherwise.
Preventing and managing, and controlling combat and operational stress
The leadership which gets the unit or troop together and helps them fight in combat as a team can also help in stress control management and avoidance. It is the duty of the leaders in the war to identify stress symptoms in any individual. Ignoring these symptoms in the early stages can lead to the deterioration of the condition of the individual to a point where professional help might be needed. Sometimes this deterioration is to an extent where the individuals are no longer able to complete day-to-day tasks and hence are not able to work or do a job (US Marine Corps, 2000). The leaders should make sure that they establish good relations with every soldier so that a behavioral change in a particular soldier can be noted. Moreover, the leaders should also make sure that they lead the troop as a family where all the soldiers look after each other.
Stress reduction techniques
In order to ensure that the leaders are able to manage stress levels in every individual, the leaders should try and reduce the stress level prevailing during combat. The leader should ensure that he takes every measure to guarantee the welfare of his troops. He should try and boost the morale of each and every individual and make them confident. This can be done by instilling confidence in the members so that they believe in every piece of equipment and unit they own.
The leaders should also ensure that every individual in the team is able to get the proper amount of sleep, food, and nutrition. They should have a comfortable place to sleep and an adequate level of privacy even though it is natural that during combat, the leaders might not be able to control a lot of these things; however, with effort and concern and with just words, the leaders can boost the courage, and morale of any individual. Leaders should also make sure that they set realistic goals for the unit members. Unreal goals, which are impossible to achieve, lead the individual to fail and then become stressed. Systematic tests and achievements of these goals can not only make a good leader but also a good soldier and hence help maintain a successful good relationship between the two.
The leaders should be able to recognize the sign of stress not only in other individuals but also in themselves also. The soldiers should also look out for different attitudes among various team members and even in their leaders. Stress has no association with being weak. Therefore, it is not true that the leaders do not have stress, and the weak members of the team are the ones who are stressed out. (US Marine Corps, 2000).
Proper information flow among the members of the team and proper communication can help the members speak out a lot of their fears which is a major cause of stress in combat. Fear in combat is a normal thing and can be experienced by the troop members and the leaders. This fear can be in the form of death, injury, or even decision making (in the case of the leader). Therefore, it is the duty of all the members to take care of the other members and notice the rarest sign of stress and behavioral change. Leaders should act as a stress control model and should create such a spirit even under stress which helps the soldiers to win even in the hardest conditions. Proper training of the individuals also leads to stress control and management.
Conclusion
The manpower loss due to combat stress is a significant loss any nation has to bear. Even though it is not completely preventable but with the help of certain measures, the number of soldiers suffering from this psychological illness can be reduced. The leaders can help bring a sense of loyalty and pride to the unit, which might help in the reduction of stress and depression. Moreover, cohesion between the unit members is also an important element that can help the soldiers reduce combat and operational stress.
Government should ensure that the service members entering the combat are satisfied that the government is going to take care of their families and will protect them. Even though it is the duty of the government and the team leaders to ensure that they help individuals to avoid and overcome stress, but it is the duty of the individuals too, to make sure that if they notice a change in their behavior, they try stress-reducing techniques and instead of denying it, work to make it better. A stressed individual in a troop can stress out others also, and even if he is not in the troop can trouble the family members. (Marine Corps, 2004).
References
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Adapted from L. J. Thompson et al., “Neuropsychiatry at Army and Division.
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