Abnormal Psychology1

The Trauma of Military Combat

Lect 19

 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 even years following the conflict. Much research has accumulated on the psychological effects of war.
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 During World War I, traumatic reactions to combat conditions were called shell shock a term coined by a British pathologist, Col. Frederick Mott (1919), who regarded these reactions as organic conditions produced by minute brain hemorrhages. It was gradually realized, however, that only a small percentage of such cases represented physical injury from the concussion of exploding shells or bombs.
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 Most victims were suffering instead from the general combat situation, with its physical fatigue, ever-present threat of death or mutilation, and severe psychological shocks. During World War II traumatic reactions to combat passed through a number of classifications, such as operational fatigue and war neuroses before finally being termed combat fatigue or combat exhaustion in the Korean and Vietnam wars.
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 The researchers found a clear intensity effect in the later development of PTSD symptoms. Individuals who had experienced high levels of combat had a greater revalence of posttraumatic stress symptoms than those who had had lower levels of combat exposure.

Clinical Picture in Combat-related Stress

The specific symptoms of combat-related stress vary considerably, depending on the type of duty, the severity and nature of the traumatic experience, and the personality of the individual. A recent study evaluating different dimensions of posttraumatic stress disorder according to the type of war-related stress experienced was conducted by Laufer, Brett, and Gallops (1985).
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 They surveyed 251 Vietnam veterans and, on the basis of the veterans' self-reports, grouped them according to three levels of experienced 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 stress symptoms were reported by individuals who had been exposed to different types of war trauma.
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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 severe pathologies 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 present identical symptoms. Despite variations in experience, the general clinical picture was uniform for soldiers who had developed combat stress in different wars. The first symptoms had been a failure to maintain psychological integration, with increasing irritability and sensitivity, sleep disturbances, and often recurrent nightmares and anxiety.
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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 to remove 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.
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Causal Factors in Combat Stress

In a combat situation, with the continual threat of injury or death and repeated narrow escapes, a person's ordinary coping methods are relatively useless. Nevertheless Not all soldiers subjected to combat became psychiatric 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.
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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 combat situations-such as severe climatic conditions, malnutrition, disease and the strain of continual emotional mobilization, will result in a general lowering of an individual's physical and psychological resistance to all stressors.

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Psychosocial factors. A number of psychological and interpersonal factors may contribute to the overall stress experienced by soldiers and predispose them to break down under combat. Such factors include reductions in personal freedom, 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 killing, and prolonged harsh conditions.
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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 stemming from parental overprotection-is commonly cited as making a soldier more vulnerable to combat stress.
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 Worthington (1978) found that American soldiers who experienced problems readjusting after they returned home from the Vietnam War also tended to have had greater difficulties before and during their military service than soldiers who adjusted readily. A background of personal maladjustment does not always make an individual a poor risk for 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 are feeling severe anxiety for the first time may be terrified by the experience, lose their selfconfidence, and go to pieces. It has also been observed that sociopaths (antisocial personalities), though frequently in trouble during peacetime service for disregarding rules and regulations, have often demonstrated good initiative & effective combat aggression against the enemy.
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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 adjustment to combat. These general factors include clarity and acceptability of war goals. war goals have a supportive effect on a soldier if they can be integrated into the soldier's values and the worth and importance of what he/she is doing. identification with the combat unit, & quality of leadership.
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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 syndrome among Vietnam combat veterans are often difficult to relate explicitly to combat stress because these individuals may also have other 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 by memories of killing enemy soldiers or civilians that are tinged with feelings of guilt and anxiety.
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The Trauma of Being a Prisoner of War or in a Concentration Camp

The residual damage to survivors of Nazi concentration 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 attributed not 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).

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 Some writers, e.g. Krystal & Niederland (1968), have contended that concentration camp survivors carry psychological scars with them 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 are studied they have been shown to be remarkably resilient and well functioning over time (Kahana, et al, 1988; Leon et al., 1981).
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The Trauma of forced Relocation

Being uprooted from home is a threatening event that violates a person's sense of security. the trauma of refugees who are forced not only to leave their homes but also their homelands and to face the stress of adapting to a new and unfamiliar culture.
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 Many factors contribute to breakdown under excessive stress, including the intensity or harshness the stress situation, the length of the 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 the trauma. The treatment of stress-related psychological problems is most effective when intervention is applied early. Crisis intervention therapy, a brief problemfocused counseling approach, may aid a victim of a traumatic event in readjusting to life after the stressful situation has ended.
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 In some situations it may be possible to prevent 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.
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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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 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 extreme trauma 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)
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UNRESOLVED ISSUES

Thank You

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