No Magic Bullet: Effective Combat Stress Control Programs

“My Lord, I must give up. I am grown so nervous that when there is any service to be done it works upon my mind so that it is impossible for me to sleep at nights. I cannot possibly stand it and I shall be forced to retire.”

From a letter to Lord Wellington
By Lieutenant–General Sir Thomas Picton
– Commander, British 5th Division, Battle of Waterloo, 1815
– Killed in Action

From generals to the enlisted in the lowest ranks, everyone in the military is vulnerable to combat or operational stress. Colonel Richard Jahne, United State Marine Corps (Retired), often said that we experienced “100% casualties” in the Vietnam War. Something about the experience left a dent in the minds and hearts (and sometimes in the bodies) of all those who were there. Any war has the capacity to seriously stress its participants and its victims. Combat stress takes a huge toll on the personnel in every branch of our military. Recent studies indicate that around 19% of them have Post Traumatic Stress Disorder and many others have other negative psychological reactions to combat stress. Combat stress is a real experience, not an imagined one. It has physiological as well as psychological manifestations. Combat/operational stress can lead to dire consequences that impair, and sometimes end, the lives of those who suffer its ill effects.

Warfare, without doubt, is among the most distressing circumstances that human beings endure. To be separated from family, friends and familiar locations for long periods is sufficient enough to produce stress reactions in most healthy people. Furthermore, deaths and injuries to friends and colleagues are emotionally devastating and cause intense grief reactions. Add in the constant threat of personal maiming or death and contributions to the killing of others and the result is extremely high levels of psychological arousal, aggression, anxiety, and fear. Even supportive but dangerous activities, far from the actual combat zones, can cause high levels of distress. When stress is sustained for long periods of time, or if it is extreme, and especially when both conditions of duration and high-intensity are combined, stress produces a wide range of negative effects that are not easy to counteract. Even the most mentally healthy and stable individuals experience some personal changes after exposure to combat/operational stress.

Stress is defined as an elevation in the levels of cognitive, physical, and emotional arousal. We can expect plenty of arousal when people are in a combat zone. Some may be angrier, more irritable and more “super alert” than others. Some experience rage feelings. Others become depressed and withdrawn. Substance abuse to manage distress is one possible choice for people working in a combat zone. Some become despondent and suicidal. Panic attacks are not uncommon. Alterations to an individual’s personality may be caused by combat/operational stress. Among the many possible reactions to combat/operational stress is Post Traumatic Stress Disorder (PTSD). It is the most highly publicized and is typically the most severe reaction to horrible events, but it is not the only one.

Unfortunately some in the military, especially those in the mental health field, seek the “magic bullet” that will prevent or cure all combat stress reactions. The reality is that the magic bullet simply does not exist. Efforts to find a single technique, drug, or therapy to manage combat stress are exercises in futility. Simplistic solutions rarely solve complex problems and combat stress is a complex problem.

A comprehensive, systematic and multi-component approach to combat/operational stress has the best chance of success in mitigating the harmful effects of stress and restoring people to healthy life functions. No single tactic, process, or therapy by itself is likely to resolve stress reactions for all people. An individual’s personality, background, specific experiences, and the availability of supportive resources will greatly influence his or her recovery.

The first step in building an effective combat/operational stress program for military personnel is a strong commitment on the part of the highest levels of command to institute comprehensive stress support programs. The next step is to develop a set of reasonable policies that encourage, protect, and guide combat/operational stress management programs.

Once a military organization endorses a stress control program and develops appropriate policies, a comprehensive, integrated, systematic and multi-component combat/operational stress program should start with educational components that intellectually prepare military personnel for common concerns and difficulties experienced during military deployments. Stress education programs should aim at helping military personnel to understand that stress reactions during deployments are common and are not signs of weakness or instability. Personnel preparing for deployment should be provided with a wide range of techniques that may help them to recognize and reduce tension and distress and assist them to maintain self control while under duress. One essential element of a stress preparation program is to assist personnel in getting home issues in order to reduce the possibility of distractions while deployed.

Part of the pre-deployment preparation is the development and enhancement of Combat Operational Stress Control teams to support deployed personnel. These teams should include professional mental health personnel as well as non-mental health military personnel who can serve as peer support. Additional training should be provided to team members to prepare them to assess and assist others in duress. A variety of stress and crisis intervention tactics should be available for use by team members. Stress control tactics should include but not be limited to assessment and strategic planning procedures. Stress control team members should be well-skilled in supporting individuals in distress. Combat stress control teams should provide rest facilities in relatively safe zones to help recover distressed personnel.

Part of the support process is the ability and authority to advocate on behalf of distressed personnel. Combat stress teams should be able to provide large group support services as well as small group crisis intervention services. They should also be proficient at providing consultations to command staff. Combat stress control teams should be allowed to be innovative in providing support services since the needs of individual deployed personnel may vary greatly. Chaplains frequently play key roles in combat stress control programs and linkages should be in place between the stress specialists and the chaplains assigned to specific units.

Once deployments are complete, comprehensive stress management programs must be in place to assist returning personnel to re-engage with their normal lives. Post-deployment stress control programs should include additional stress education, individual and group counseling, family support programs, employment counseling for those separating from the military, recreational programs and links to psychological therapy and other services.

The most valuable military resources are not the expensive and sophisticated equipment used by military units. The most valuable resources of all are the men and women who serve this nation. They have a right to support services and recovery programs after grueling exposures to high intensity stress, threats, and gruesome exposures to the darkest aspects of human nature.