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.
(1) The most common stress reactions are simply inefficient
performances, such as:
- Slow thinking (or reaction time).
- Difficulty sorting out the important from all the noise and
seeing what needs to be done.
- Difficulty getting started.
- 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will be very withdrawn and silent and try to isolate themselves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 BEEN DETERMINED.
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 reexperiencing of the stressful event may be
necessary for eventual recovery; therefore, it should not be discouraged
or viewed as abnormal. For the person reexperiencing 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.
e. Psychiatric 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.
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