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Field Manual No. 22-51: Leaders' Manual for Combat Stress Control: Booklet 1

Chapter 11: Prevention of Battle Fatigue Casualties and Misconduct Stress Behaviors

Headquarters, Department of the Army, Washington, DC

11-1. Introduction
In combat, battle fatigue is inevitable but high battle fatigue casualty rates are not. History shows that highly trained and cohesive units with good leadership have had fewer than one such casualty for every ten WIA, even in intensely heavy fighting. This is significantly fewer than the usual one per four or five in moderate intensity battle and one per two or three in intense fighting. By knowing what factors in the tactical and overall situation increase battle fatigue, leaders and unit members can take action to counteract those factors. They must share the burden, resolve internal conflicts, build unit cohesion, and reduce stress. The same measures, plus positive adherence to discipline and the Law of Land Warfare, also prevent misconduct stress behaviors which could defeat the purpose of the mission. We can overcome the stressors of the battlefield --

  • Through tough, realistic training which builds confidence.

  • By looking out for each other.

11-2. Leader's Role in Training Battle Fatigue Prevention
a. History shows what kinds of situations and stressors tend to produce battle fatigue casualties. Some are conditions which can be modified or controlled by good leadership. Other situations or events may be beyond the leader's control; however, knowing which situations or events increase stress and battle fatigue enables the leader to compensate by reducing other stressors and taking corrective actions. The leader must also plan for the care of battle fatigue casualties and still accomplish the mission.

b. Mental health/combat stress control personnel have the mission to give formal training and consultation on how to reduce stressors. This training and consultation is provided to both medical and line officers, NCOs, chaplains, and troops.

c. Appendix E elaborates on material which is part of the Advanced NCO Course and Advanced Officer Course core curricula. The same material is also outlined in GTAs 21-3-4, -5, and -6. These GTAs are designed to facilitate "hip pocket training" in the field. They are camouflaged pocket cards which should be available through all Army Training and Audiovisual Support Centers. The GTAs can serve as training aids in peacetime and as reminders and checklists in war.

11-3. What the Members of the Unit Can Do to Control Stress
a. Unit leaders and members can control stress by assisting one another. They need to be able to recognize stress in each other. One important way in which stress can be alleviated is by talking things out ("ventilation"). This requires encouragement and listening to the soldier under stress. Realistic reassurance is helpful. Arguing with the soldier and being critical or disparaging usually is not helpful. Ways which unit leaders and members can assist one another in controlling stress may include --

  • All soldiers being assigned or developing "battle buddies" with whom they share their feelings and ventilate about their experiences.

  • Officers and NCOs in the same unit encouraging each other to talk things out together, especially those issues or feelings they cannot share with their troops.

  • Officers and NCOs in sister units providing ventilation for each other.

  • Officers and senior NCOs in the chain of command, chain of support, and staff positions encouraging junior leaders to talk freely about their feelings at suitable times and places without fear of reprisal. Formal after-action debriefings of the unit leaders after difficult actions are one example of suitable times. Another example is during change of command transition workshops.

  • The unit chaplain being someone that anyone can ventilate to about anything.

b. Should a unit member be in a crisis, a number of actions may be useful. These actions are to --

  • Observe and attempt to calm the soldier.

  • Protect him from danger (restrain only if necessary).

  • Ensure that someone takes charge of the situation, finds out what is going on, and takes appropriate action. Specific actions which should be taken by a buddy or junior leader are outlined in GTA 21-3-4 and -5.

11-4. What the Individual Can Do to Control Combat Stress
a. Individuals must drink enough fluids, eat enough food, and attempt to get rest/ sleep as often as possible.

b. Everyone should learn at least two relaxation techniques (and preferably more) that can be used at times when physical exercise is not feasible.

  • One technique should provide quick reduction of excessive alertness without taking the mind, eyes, or hands off the task.

  • A second technique should provide deep relaxation for refreshing sleep even under high-stress situations.

c. Care must be taken to use relaxation techniques only at tactically appropriate times. Mental health personnel can assist in teaching these methods. Useful techniques which can be used alone or in combination include --

  • Visual imaging self-relaxation. Imagine yourself in a relaxing situation. Pick your own relaxing situation, then imagine it with every sense of your body -- colors, shapes, textures, sounds, smells, temperature, and touch of it.

  • Brief or progressive muscular relaxation. Tense your muscles for a few seconds (approximately 5-10) and then slowly release this tension while feeling the warm and heavy sensation that occurs when you relax. Either tense all your muscles at once or start with the muscles in your toes and work slowly up the muscles in the rest of your body.

  • Stretching. Stretch your muscles and joints, move them around, and shake out the tension.

    Caution:
    When the soldier must stay alert and be responsive to the environment, special relaxation techniques can be used that will not disrupt performance. In such situations, deep relaxation techniques would be tactically inappropriate and unsafe.

  • Positive self-talk. Say to yourself, "Easy does it," "Take your time," "I can do it," "OK, go for it!" or any other brief words of encouragement.

  • Abdominal breathing. Breathe slowly and deeply, using the abdominal muscles (not the chest muscles) to move the air in and out. Even one slow breath in which you breathe in, hold for 2-3 seconds, and then exhale slowly (about 5 seconds) can steady the nerves and refocus attention.

  • Breathing meditation. Focus your attention on your breathing, especially each time you breathe out. Say the same word or short phrase once each time you exhale (such as the word "one" or "relax"), over and over, while passively letting all other thoughts drift out of your mind.

d. Individuals should share feelings constructively ("ventilation").

e. Individuals can also reduce stress by planning ahead, preparing for the mission, and ensuring readiness. The best way to alleviate stress is to take appropriate action. The above techniques should be practiced frequently until they become automatic.

11-5. Prevention of Misconduct Stress Behaviors
The measures which reduce battle fatigue and prevent battle fatigue casualties should also help reduce the incidence of misconduct stress behaviors. However, additional actions also need to be practiced consistently by leadership at all echelons and by buddies at the small unit level.

a. Clearly state and teach the Standards of Conduct. United States forces will faithfully adhere to the Law of Land Warfare and the UCMJ.

b. Reemphasize those standards repeatedly, especially every time they are violated by the enemy or at the first early signs of slippage by our troops. Some of the early signs may include talking about breaking the law, stretching the interpretation, or committing acts in the "gray" areas which cannot be documented for legal action. Let troops express (ventilate) their frustrations verbally among themselves, but not in action.

c. Emphasize national, Army, and unit pride in living by the standard even under provocative conditions. "We are American soldiers of the (unit). I know how you feel, but we do not do that stuff. Those who do have let us down and are no longer part of us."

d. Explain, as often as necessary, the ethical, legal, practical, and tactical reasons why we obey the rules. For example, "Provoking us to commit atrocities is exactly what the enemy is trying to do to achieve his objectives, not ours." Restate the mission and its objectives clearly.

e. Clearly state and consistently enforce the rules and regulations against substance abuse, fraternization, and misconduct. Develop a group sense of "family" that makes such improper behavior morally and spiritually unacceptable as well as illegal and punishable.

f. Set the personal example of correct conduct.

g. Report all violations.

h. Prosecute all verifiable violations.

i. Consistently and fairly punish misconduct and violation of the UCMJ in peacetime to set the standard that misbehavior will not be tolerated.


 

 

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Bureau of Medicine and Surgery
Department of the Navy
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Operational Medicine
 Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
  January 1, 2001

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