How would one describe the visible signs of emotional or psychological turmoil associated with combat observed during a deployment, and what avenues exist for managing it?
Most combat occurs at what is called the “small unit” level. The U.S. Army is structured – and this is in no way meant to detract from the contributions of the Marine Corps, but is simply focused on the Army for illustrative purposes – into a hierarchy that begins with squads of 10-15 soldiers apiece; three squads form a platoon; three platoons form a company; and so on all the way up to division, corps and army levels. It is at the squad and platoon levels that most soldiers experience the majority of their combat experience. In such small units, individual soldiers get to know each other pretty well, sharing sleeping quarters, eating together, killing time between patrols together, and, of course, patrolling and fighting side-by-side. They become personally close and often share intimate details of their lives outside of the military. They rely on each other and place their lives in each other’s hands. The bond that is formed is unbreakable.
It is within this context that indications of the enduring toll being taken on one’s psyche may first become apparent. Because these soldiers learn to know each so well, they can often detect the subtle and not-so-subtle signs that one of their comrades may be reaching a breaking point. Identifying or recognizing these signs is vital if a potential tragedy – possibly including a massacre of civilians out of a sense of frustration or a suicide – is to be averted. The U.S. Army lists these as the “Symptoms of Battle Fatigue”:
(1) “Thousand-yard stare” (normal and common after heavy combat; improves with 1 to 2 days rest).
(3) Tension, startle response, fine tremors (becomes selective in veterans, but increases again with sleep loss and cumulative combat).
(4) Psychological symptoms (normal and very common).
- Back pain.
- Nausea, vomiting.
- Bowel and urinary symptoms.
(5) Irritability (warning signs – silent, withdrawn, or “vicious” in own group).
(6) Inability to concentrate.
(7) Insomnia, terror dreams (afraid to sleep; therefore symptoms get worse).
(8) Inertia, indecision, tiredness (can lead to mistakes and increased stress).
(9) Depression (motor retardation, crying, survivor guilt).
(10)Anxiety reactions (gross tremors, extreme startle).
(11)Memory loss (amnesia, complete or partial).
Soldiers for whom these symptoms are noticeable are, under ideal conditions, removed from front-line combat units and reassigned to noncombat units while undergoing psychiatric evaluation. To the extent they are able to recognize troubling changes in themselves and possible even self-diagnose the possibility of combat fatigue or post-traumatic stress disorder, they will hopefully confide in their superiors and communicate with friends and colleagues. In a major combat zone, however, with each soldier relying on the soldiers near him or her, many are reluctant to admit to experiencing psychological trauma associated with their military service. In addition to wanting to avoid the stigma associated with a mental disorder, many soldiers do not to be seen as abandoning their colleagues. It therefore becomes incumbent upon those colleagues to watch for the symptoms and handle them accordingly. To the self-diagnosed “strong and silent” types, the risk is greater that an emotional rupture will occur resulting in the aforementioned tragedy.