Reactions to Stress
Most people react to misfortune or disasters (military
or civilian, threatened or actual) after the situation has passed. All people
feel some fear. This fear may be greater than they have experienced at any other
time, or they may be more aware of their fear. In such a situation, they should
not be surprised if they feel shaky, become sweaty, nauseated or confused. These
reactions are normal and are not a cause for concern. However, some reactions,
either short or long term, will cause problems if left unchecked. The following
are consequences of too much stress:
a. Emotional Reactions.
The most common stress reactions are simply inefficient performances, such
Slow thinking (or reaction time).
Difficulty sorting out
the important from all the noise and seeing what needs to be done.
Indecisiveness, trouble focusing attention.
A tendency to do familiar tasks and be preoccupied with familiar details. This
can reach the point where the person is very passive, such as just sitting or
wandering about not knowing what to do.
(2) Much less common reactions
to a disaster or accident may be uncontrolled emotional outbursts, such as crying,
screaming, or laughing. Some soldiers will react in the opposite way. They will
be very withdrawn and silent and try to isolate themselves from everyone. These
soldiers should be encouraged to remain with their assigned unit. Uncontrolled
reactions may appear by themselves or in any combination (the person may be crying
uncontrollably one minute and then laughing the next or he may lie down and babble
like a child). In this state, the person is restless and cannot keep still. He
may run about, apparently without purpose. Inside, he feels great rage or fear
and his physical acts may show this. In his anger he may indiscriminately strike
out at others.
b. Loss of Adaptability.
(1) In a desperate attempt
to get away from the danger which has overwhelmed him, a person may panic and
become confused. In the midst of a mortar attack, he may suddenly lose the ability
to hear or see. His mental ability may be so impaired he cannot think clearly
or even follow simple commands. He may stand up in the midst of enemy fire or
rush into a burning building because his judgment is clouded and he cannot understand
the likely consequences of his behavior. He may lose his ability to move (freezes)
and may seem paralyzed. He may faint.
(2) In other cases, overwhelming stress
may produce symptoms which are often associated with head injuries. For example,
the person may appear dazed or be found wandering around aimlessly. He may appear
confused and disoriented and may seem to have a complete or partial loss of memory.
In such cases, especially when no eye witnesses can provide evidence that the
person has NOT suffered a head injury, it is necessary for medical personnel
to provide rapid evaluation for that possibility. DO NOT ALLOW THE SOLDIER TO
EXPOSE HIMSELF TO FURTHER PERSONAL DANGER UNTIL THE
CAUSE OF THE PROBLEM HAS
c. Sleep Disturbance and Repetitions. A person who
has been overwhelmed by disaster or some other stress often has difficulty sleeping.
The soldier may experience nightmares related to the disaster, such as dreaming
that his wife, father, or other important person in his life was killed in the
disaster. Remember that nightmares, in themselves, are not considered abnormal
when they occur soon after a period of intensive combat or disaster. As time passes,
the nightmares usually become less frequent and less intense. In extreme cases,
a soldier, even when awake, may think repeatedly of the disaster, feel as though
it is happening again, and act out parts of his stress over and over again. For
some persons, this repetitious re-experiencing of the stressful event may be necessary
for eventual recovery; therefore, it should not be discouraged or viewed as abnormal.
For the person re-experiencing the event, such reaction may be disruptive and
disturbing regardless of the reassurance given him that it is perfectly normal.
In such a situation, a
short cut that is often possible involves getting the
person to talk extensively, even repetitiously, about the experience or his feelings.
This should not be forced; rather, the person should be given repeated opportunities
and supportive encouragement to talk in private, preferably to one person. This
process is known as ventilation.
d. Other Factors. In studies
of sudden civilian disasters, a rule of thumb is that 70 to 80 percent of people
will fall into the first category (a above). Ten to 15 percent will show
the more severe disturbances (b and c above). Another 10 to 15 percent
will work effectively and coolly. The latter usually have had prior experience
in disasters or have jobs that can be applied effectively in the disaster situation.
Military training, like the training of police, fire, and emergency medical specialists
in civilian jobs, is designed to shift that so that 99 to 100 percent of the unit
works effectively. But sudden, unexpected horrors, combined with physical fatigue,
exhaustion, and distracting worries about the home front can sometimes
throw even well-trained individuals for a temporary loss.
Complications. Although the behaviors described (a through c
above) usually diminish with time, some do not. A person who has not improved
somewhat within a day, even though he has been given warm food, time for sleep,
and opportunity to ventilate, or who becomes worse, deserves specialized medical/psychiatric
care. Do not wait to see if what he is experiencing will get better with time.
Severe Stress or Battle Fatigue Reactions
You do not need specialized
training to recognize severe stress or battle fatigue reactions that will cause
problems to the soldier, the unit, or the mission. Reactions that are less severe,
however, are more difficult to detect. To determine whether a person needs help,
you must observe him to see whether he is doing something meaningful, performing
his duties, taking care of himself, or behaving in an unusual fashion or acting
out of character.
Application of Psychological First Aid
The emotionally disturbed soldier
has built a barrier against fear. He does this for his own protection, although
he is probably not aware that he is doing it. If he finds that he does not have
to be afraid and that there are normal, understandable things about him, he will
feel safer in dropping this barrier. Persistent efforts to make him realize that
you want to understand him will be reassuring, especially if you remain calm.
Nothing can cause an emotionally disturbed person to become even more fearful
than feeling that others are afraid of him. Try to remain calm. Familiar things,
such as a cup of coffee, the use of his name, attention to a minor wound, being
given a simple job to do, or the sight of familiar people and activities will
add to his ability to overcome his fear. He may not respond well if you get excited,
angry, or abrupt.
a. Ventilation. After the soldier becomes calmer,
he is likely to have dreams about the stressful event. He also may think about
it when he is awake or even repeat his personal reaction to the event. One benefit
of this natural pattern is that it helps him master the stress by going over it
just as one masters the initial fear of jumping from a diving board by doing it
over and over again. Eventually, it is difficult to remember how frightening the
event was initially. In giving first aid to the emotionally disturbed soldier,
you should let him follow this natural pattern. Encourage him to talk. Be a good
listener. Let him tell, in his own words, what actually happened (or what he thinks
happened). If home front problems or worries have contributed to the stress,
it will help him to talk about them. Your patient listening will prove to him
that you are interested in him, and by describing his personal catastrophe, he
can work at mastering his fear. If he becomes overwhelmed in the telling, suggest
a cup of coffee or a break. Whatever you do, assure him that you will listen again
as soon as he is ready. Do try to help put the soldier’s perception of what happened
back into realistic perspective; but, DO
NOT argue about it. For example,
if the soldier feels guilty that he survived while his teammates were all killed,
reassure him that they would be glad he is still alive and that others in the
unit need him now. If he feels he was responsible for their deaths because of
some oversight or mistake (which may be true), a nonpunishing, nonaccusing attitude
may help him realize that accidents and mistakes do happen in the confusion of
war, but that life, the unit, and the mission must go on. (These same principles
apply in civilian disaster settings as well.) With this psychological first aid
measure, most soldiers start toward recovery quickly.
A person who is emotionally disturbed as the result of a combat action or a catastrophe
is basically a casualty of anxiety and fear. He is disabled because he
has become temporarily overwhelmed by anxiety. A good way to control fear is through
activity. Almost all soldiers, for example, experience a considerable sense
of anxiety and fear while they are poised, awaiting the opening of a big offensive;
but this is normally relieved, and they actually feel better once they begin to
move into action. They take pride in effective performance and pleasure in knowing
that they are good soldiers, perhaps being completely unaware that overcoming
their initial fear was their first major accomplishment.
(2) Useful activity
is very beneficial to the emotionally disturbed soldier who is not physically
incapacitated. After you help a soldier get over his initial fear, help him to
regain some self-confidence. Make him realize his job is continuing by finding
him something useful to do. Encourage him to be active. Get him to carry litters,
(but not the severely injured), help load trucks, clean up debris, dig foxholes,
or assist with refugees. If possible, get him back to his usual duty. Seek out
his strong points and help him apply them. Avoid having him just sit around. You
may have to provide direction by telling him what to do and where to do it. The
instructions should be clear and simple; they should be repeated; they should
be reasonable and obviously possible. A person who has panicked is likely to argue.
Respect his feelings, but point out more immediate, obtainable, and demanding
needs. Channel his
excessive energy and, above all, DO NOT argue. If you cannot
get him interested in doing more profitable work, it may be necessary to enlist
aid in controlling his overactivity before it spreads to the group and results
in more panic. Prevent the spread of such infectious feelings by restraining and
segregating if necessary.
(3) Involvement in activity helps a soldier in three
He forgets himself.
He has an outlet for his excessive
He proves to himself he can do something useful. It is amazing
how effective this is in helping a person overcome feelings of fear, ineffectiveness,
c. Rest. There are times, particularly in combat, when
physical exhaustion is a principal cause for emotional reactions. For the weary,
dirty soldier, adequate rest, good water to drink, warm food, and a change of
clothes, with an opportunity to bathe or shave may provide spectacular results.
Group Activity. You have probably already noticed that a person works, faces
danger, and handles serious problems better if he is a member of a closely-knit
group. Each individual in such a group supports the other members of the group.
For example, you see group spirit in the football team and in the school
fraternity. Because the individuals share the same interests, goals, and problems,
they do more and better work; furthermore, they are less worried because everyone
is helping. It is this group spirit that wins games or takes a strategic hill
in battle. It is so powerful that it is one of the most effective tools
you have in your “psychological first aid bag.” Getting the soldier back into
the group and letting him see its orderly and effective activity will reestablish
his sense of belonging and security and will go far toward making him a useful
member of the unit.
Reactions and Limitations
a. Up to this point the discussion has
been primarily about the feelings of the emotionally distressed soldier. What
about your feelings toward him? Whatever the situation, you will have emotional
reactions (conscious or unconscious) toward this soldier. Your reactions can either
help or hinder your ability to help him. When you are tired or worried, you may
very easily become impatient with the person who is unusually slow or who exaggerates.
You may even feel resentful toward him. At times when many physically wounded
lie about you, it will be especially natural for you to resent disabilities that
you cannot see. Physical wounds can be seen and easily accepted. Emotional reactions
are more difficult to accept as injuries. On the other hand, will you tend to
be overly sympathetic? Excessive sympathy for an incapacitated person can be as
harmful as negative feelings in your relationship with him. He
help, but not your sorrow. To overwhelm him with pity will make him feel even
more inadequate. You must expect your buddy to recover, to be able to return to
duty, and to become a useful soldier. This expectation should be displayed in
your behavior and attitude as well as in what you say. If he can see your calmness,
confidence, and competence, he will be reassured and will feel a sense of greater
b. You may feel guilty at encouraging this soldier to recover
and return to an extremely dangerous situation, especially if you are to stay
in a safer, more comfortable place. Remember though, that if he returns to duty
and does well, he will feel strong and whole. On the other hand, if he is sent
home as a psycho, he may have self-doubt and often disabling symptoms the
rest of his life.
c. Another thing to remind yourself is that in combat
someone must fight in this soldier’s place. This temporarily battle fatigued soldier,
if he returns to his unit and comrades, will be less likely to overload again
(or be wounded or killed) than will a new replacement.
d. Above all,
you must guard against becoming impatient, intolerant, and resentful, on one hand,
and overly solicitous on the other. Remember that such emotion will rarely help
the soldier and can never increase your ability to make clear decisions.
As with the physically injured soldier, the medical personnel will take over the
care of the emotionally distressed soldier who needs this specific care as soon
as possible. The first aid which he has received from you will be of great value
to his recovery.
f. Remember that every soldier (even you) has a potential
emotional overload point which varies from individual to individual, from time
to time, and from situation to situation. Because a soldier has reacted abnormally
to stress in the past does not necessarily mean he will react the same way to
the next stressful situation. Remember, any soldier, as tough as he may seem,
is capable of showing signs of anxiety and stress. No one is absolutely immune.
Tables. See Tables 8-1, 8-2, and 8-3 for more information.