lect 19 the trauma of military combat

7/30/2019 Lect 19 the Trauma of Military Combat

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The Trauma of

Military Combat

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War continues to take an incredible toll on

human lives and economic resources, often

leaving large numbers of victims in its wake.

The consequences of war on survivors, both

civilian and military, are often great.

Many individuals who have been involved in

war's turmoil can experience devastating

psychological problems for months or evenyears following the conflict.

Much research has accumulated on the

psychological effects of war. 2


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During World War I, traumatic reactions to

combat conditions were called shell shocka term coined by a British pathologist, Col.

Frederick Mott (1919), who regarded

these reactions as organic conditionsproduced by minute brain hemorrhages.

It was gradually realized, however, that

only a small percentage of such casesrepresented physical injury from the

concussion of exploding shells or bombs.3


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The researchers found a clear intensity

effect in the later development of PTSDsymptoms.

Individuals who had experienced high

levels of combat had a greater revalenceof posttraumatic stress symptoms than

those who had had lower levels of

combat exposure.

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Clinical Picture in Combat-related

Stress

The specific symptoms of combat-relatedstress vary considerably, depending on the

type of duty, the severity and nature of the

traumatic experience, and the personality ofthe individual.

A recent study evaluating different

dimensions of posttraumatic stress disorderaccording to the type of war-related stress

experienced was conducted by Laufer, Brett,

and Gallops (1985). 6


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They surveyed 251 Vietnam veterans and,

on the basis of the veterans' self-reports,

grouped them according to three levels ofexperienced stress:

(a) exposed to combat;

(b) exposed to abusive violence in combat;

(c) participated in abusive violence in combat.

They found that different degrees of stresssymptoms were reported by individuals who

had been exposed to different types of war

trauma. 7


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Exposure to combat and exposure to

violence were found to be associated

with later experiences of posttraumatic

symptoms, including intrusive imagery,

hyper-arousal, numbing, and cognitive

disruption.

Participation in abusive violence was

most highly associated with more severepathologies marked by cognitive

disruptions, such as depression.

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Patients who have experienced particular types

of war stress are likely to present specific types

of symptoms, and not all PTSD patients presentidentical symptoms.

Despite variations in experience, the general

clinical picture was uniform for soldiers whohad developed combat stress in different wars.

The first symptoms had been a failure to

maintain psychological integration, withincreasing irritability and sensitivity, sleep

disturbances, and often recurrent nightmares

and anxiety. 9


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it is not unusual for soldiers to admit that

they have prayed to be hit or to have

something "honorable" happen to them toremove them from battle.

When approaching full recovery & the

necessity of returning to combat, injured

soldiers sometimes show prolonged

symptoms or delayed traumatic reactions of

nervousness, insomnia, and other symptoms

that were nonexistent when they were first

hospitalized.10


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Causal Factors in Combat Stress In a combat situation, with the continual

threat of injury or death and repeated narrowescapes, a person's ordinary coping methods

are relatively useless. Nevertheless Not all

soldiers subjected to combat becamepsychiatric casualties.

Many soldiers have tolerated almost

unbelievable stress before they have broken,while others have become casualties under

conditions of relatively slight combat stress or

even as noncombatants- e.g, during training.11


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In order to understand traumatic

reactions to combat, we need to look at

factors such as constitutional

predisposition, personal maturity, loyalty

to one's unit, and confidence in one's

officers-as well as at the actual stress

experienced.

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Biological factors:

constitutional differences in sensitivity

and temperament affect a soldier's

resistance to combat stress.

Also factors that often occur in combatsituations-such as severe climatic

conditions, malnutrition, disease and the

strain of continual emotionalmobilization, will result in a general

lowering of an individual's physical and

psychological resistance to all stressors. 13


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Psychosocial factors.

A number of psychological and interpersonal

factors may contribute to the overall stressexperienced by soldiers and predispose them

to break down under combat.

Such factors include reductions in personalfreedom, frustrations of all sorts, and

separation from home and loved ones.

Central, of course, are the many stresses

arising from combat, including constant fear,

unpredictable circumstances, the necessity of

killin and rolon ed harsh conditions.14


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An individual's personality is an important

determinant of adjustment to military

experiences. Personality characteristics that lower an

individual's resistance to stress or to particular

stressors may be important in determining his

or her reactions to combat.

Personal immaturity-sometimes stemmingfrom parental overprotection-is commonly

cited as making a soldier more vulnerable to

combat stress. 15


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Worthington (1978) found that American

soldiers who experienced problems

readjusting after they returned home fromthe Vietnam War also tended to have had

greater difficulties before and during their

military service than soldiers who adjustedreadily.

A background of personal maladjustment

does not always make an individual a poor riskfor withstanding combat stress.

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Some individuals are so accustomed to

anxiety that they cope with it more or less

automatically, whereas soldiers who arefeeling severe anxiety for the first time may be

terrified by the experience, lose their self-

confidence, and go to pieces. It has also been observed that sociopaths

(antisocial personalities), though frequently

in trouble during peacetime service fordisregarding rules and regulations, have often

demonstrated good initiative & effective

combat aggression against the enemy. 17


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However, the soldiers who function most

effectively and are most apt to survive

combat usually come from backgrounds

that fostered self-reliance, the ability to

function in a group, and ready

adjustment to new situations

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Sociocultural Factors:

Several sociocultural factors play an important

part in determining an individual's adjustmentto combat.

These general factors include clarity and

acceptability of war goals. war goals have asupportive effect on a soldier if they can be

integrated into the soldier's values and the

worth and importance of what he/she isdoing.

identification with the combat unit, & quality

of leadershi .19


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Long-term Effects of Posttraumatic Stress

The nature and extent of this delayed

posttraumatic stress disorder are

somewhat controversial (Burstein, 1985).

Reported cases of delayed stress syndromeamong Vietnam combat veterans are often

difficult to relate explicitly to combat stress

because these individuals may also haveother significant adjustment problems.

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Individuals experiencing adjustment

difficulties may erroneously attribute their

present problems to specific incidents

from their past, such as experiences in

combat.

Evidently, these soldiers have suffered

long-term damage to their adaptive

capabilities, in some cases complicated bymemories of killing enemy soldiers or

civilians that are tinged with feelings of

guilt and anxiety. 21

h f i i f


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The Trauma of Being a Prisoner of War

or in a Concentration Camp

The residual damage to survivors of Naziconcentration camps was often extensive

and commonly included anxiety,

insomnia, headaches, irritability,

depression, nightmares, impaired sexual

potency, and "functional" diarrhea (which

occurs in any situation of stress, even

relatively mild stress).

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Such symptoms

Were attributednot only to the

psychological

stressors but

Also To

Biological stressors, such as head injuries,prolonged malnutrition, and serious

infectious diseases (Eitinger, 1964, 1969,

1973; Sigal et al., 1973; Warnes, 1973). 23

S i l & i d l d


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Some writers, e.g. Krystal & Niederland

(1968), have contended that concentration

camp survivors carry psychological scars withthem for the rest of their lives. & that these

emotional scars are so profound that they can

be transmitted to the survivors' children(Epstein, 1979; Schneider, 1978).

In fact, when community (nonpsychiatric)

samples of concentration camp survivors arestudied they have been shown to be

remarkably resilient and well functioning over

time (Kahana, et al, 1988; Leon et al., 1981).24

The Trauma of forced


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The Trauma of forced

Relocation

Being uprooted fromhome is a threatening

event that violates a

person's sense of

security.

the trauma of refugees who are forced notonly to leave their homes but also their

homelands and to face the stress of adapting

to a new and unfamiliar culture.25


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Many factors contribute to breakdown under

excessive stress, including the intensity or

harshness the stress situation, the length ofthe traumatic event, the individual's

biological makeup and personality,

adjustment prior to the stressful situation,the ways in which the person manages

problems once the stressful situation is over.

In many cases the symptoms recede as the

stress diminishes, especially if the individual

is given supportive psychotherapy.

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In extreme cases, however, there may be

residual damage or the disorder may not

actually occurring until some time after thetrauma.

The treatment of stress-related

psychological problems is most effective

when intervention is applied early.

Crisis intervention therapy, a brief problem-focused counseling approach, may aid a

victim of a traumatic event in readjusting to

life after the stressful situation has ended.27


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In some situations it may be possible toprevent maladaptive responses to stress by

preparing an individual in advance to deal

with the stress.

This approach to stress management has been

shown to be effective in cases where the

individual is facing a known traumatic event,

such as major surgery or the breakup of

a relationship.28


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In these cases a professional attempts to

prepare the individual in advance to cope

better with the stressful event through

developing more realistic and adaptive

attitudes about the problem.

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UNRESOLVED ISSUES


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UNRESOLVED ISSUES Posttraumatic stress disorder has been used

frequently in recent criminal and civil court

cases to explain deviant behavior or to justify

compensation for perceived damages.

In some situations, especially when extremetrauma has been involved, the maladaptive

behavior is readily explainable in terms of the

traumatic event. In other situations, a causal link between

maladaptive behavior and a traumatic event

has been difficult to establish. (policeman)30


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Thank You

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lect 19 the trauma of military combat

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