Psychology During and After Combat

The likelihood of becoming a psychiatric casualty of combat has shown to be greater than the possibility of being killed in the same war. Traditionally losses have been measured by financial means or numbers of personnel physically wounded or killed. Humanely, psychiatric breakdowns have been the greatest loss in any war in the past century. History portrays both positive and negative psychological adjustments used by soldiers in combat, the military, and society, and follows deeper approaches to understanding both causes and effective treatments.

Stress on the Battle Field

New understandings of combat stress have allowed soldiers, physicians, and society as a whole to adjust to battle more effectively than in past wars. Combat stress reaction characterizes a variety of actions, resulting from the stress of being in a battle zone, that reduces an individuals combat effectiveness. Typically this reaction, also known as battle fatigue and shell-shock, follows continuous combat operations, more prevalent in recent wars, although fragmented examples can be found in writings from the Civil War. Jacob Mendez da Costa, after examining soldiers in an examination room in 1871, coined the phrase “Soldier’s Heart” to describe an anxiety attack caused by combat stress.

Only months after beginning WWI, “shell-shock” became a popular term to describe the effects on a soldier after an artillery shell exploded near them. At the time they were believed to be concussive symptoms, or possibly even symptoms of chemical poisoning. Charles Myers, after first recording these symptoms in The Lancet and developing a cultural adaptation of the previously military-term, discovered that often these symptoms were present also in soldiers that were never close enough to the explosions to have physical effects (Shepard, p.21). Although many of these cases recorded during the first world war were most likely cases of combat stress, there also may be a similar link to some “shell-shock” patients and today’s “traumatic brain injury” cases from improvised explosive devices in Iraq and Afghanistan.

The Second World War and Korea saw the beginning of a new development in psychiatry, as the military

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and psychologists worked together to create a more productive military might through mental health screening and a new approach to diagnosis. Phrases such as “battle fatigue” and “combat exhaustion” were replacing the previous “shell-shock.”

Soldiers with negative reactions were no longer looked at as the weak subjects they had been before by the military or by society. Finally an understanding that all people have a “breaking point” allowed the fear to decrease. Psychology had witnessed numerous men develop physical inabilities through mental stress, and finally were seeing that this was not just a symptom of the mentally frail but of war. This shift would encourage soldiers with symptoms to seek help before they’re situation had put them out of combat entirely.

Post-Traumatic Stress Disorder

Combat stress reaction , like any psychological adjustment to war, can lead to permanent problems if not treated appropriately early on in the symptoms. An acute stress reaction is a psychological response to a terrifying event that causes disturbing and extreme fear of harm or danger, and is an example of post traumatic stress disorder (PTSD). An anxiety disorder, PTSD develops after exposure to a traumatic and often terrifying event, and characterizes an intense and continuous emotional response to the psychological trauma of the experience. The disorder, in extreme cases, will prevent the sufferer from engaging in normal activities and separate them from society. Vietnam gave the American military the impression that they had found the solution to combat stress and losing fighting strength to psychiatric casualties. Soldiers were sent to battle for a period of one year, with a date of return to arrive. With a definitive countdown, soldiers did not wait for the unknown day of re-deployment; they knew when it would come. This gave a sense of security, and a goal. Just a little while longer, they could tell themselves. When their tour was complete, soldiers would leave Vietnam alone just as they had left the States a year prior. Although the trauma they experienced was great during combat, and many experienced horrors most would never imagine, the number of psychiatric casualties leaving the battlefield was incredibly low. After being left by their friends and then leaving themselves, many soldiers felt a guilt for abandoning those they had once mentored or fought with in combat, only to return to a country filled with protesters, ranting, calling them “baby killers” and “murderers” in a place that had been their home before they went to war. This display put a great deal of stress on the individual returning, and with no support group around them, many began to develop psychological symptoms, such as avoidance and hyper arousal. Many would be deemed crazy and unfit to live intheir communities.  soldiers returning from Iraq today are experiencing anxiety and depression in higher numbers, similar to those in Vietnam veterans.  Today, however, treatment of PTSD includes not only sessions with psychologists or other physicians, but also medications for anxiety, depression, and insomnia. After recent tours in Iraq, soldiers are immediately assessed for psychological disruptions, demonstrating the military’s preventive and early treatment methods.

Positive Adjustments to Battle

Although stress will always be a major factor in developing psychological disorders, combatants, doctors, and the country as a whole must not dismiss the importance of stress reactions on the battle field, and of the positive adjustments battle will induce in the individual. Stress will bring about a constant alertness, which may be tiring but also life-saving. The reliance on their peers allows soldiers to develop life-long friends and learn to trust. With proper support and careful monitoring, battle can increase self-esteem and build stronger citizens.

Stress disorders induced by intense trauma or long exposures to combat will continue to be a problem the military will endure. The earliest acknowledgement of a problem in a soldier, however, and the most efficient treatment will help that individual recover and maintain morale of the group. Although some humans are more likely to develop negative reactions to stress, all people are effected in some way and can be “broken” with inadequate conditions for sustained periods.