ABSTRACT
Introduction .......................................................................................................... 26 A Brief History of Combat Psychiatry .............................................................. 27 Combat and Operational Stress Control .......................................................... 29 Combat and Operational Stress Reactions ....................................................... 29 Prevention and Preparation through Training ................................................ 30 COSC on the Battlefi eld .......................................................................................31 Deployment Cycle Support ................................................................................. 33
Predeployment Support .................................................................................. 33 Predeployment Mental Health Screening .................................................... 34 Deployment Support ....................................................................................... 34 Redeployment/Postdeployment Support ..................................................... 34
Managing Stress-Related Disorders in Th eater ............................................... 36 Depression ........................................................................................................ 36 Anxiety ............................................................................................................. 37 Sleep Disorders ................................................................................................ 38
Chronic Combat Stress Reactions: Treatment Issues ...................................... 39 Conclusions and Recommendations ................................................................. 40 References .............................................................................................................. 41
It seems clear that people can behave with great resilience, even heroism, in circumstances when experts beforehand had predicted mass panic and civil breakdown. One reason may be that people can see a wider purpose to accepting these risks, and also become active participants in the process. —Simon Wessely (Risk, Psychiatry, and the Military, 2005)
Th e goal of this chapter is to address the current status and practice of military psychiatry to identify and manage mental health issues in the military. In particular, we consider the strengths and the limitations of current practice as they relate specifi cally to vulnerability or resilience to stress. Here, we defi ne resilience as the ability to adjust easily to stress or to recover quickly and eff ectively from exposure to stress. It is important to note, however, that formal military doctrine does not refer to “resilience” per se but rather emphasizes the importance of “enhancing adaptive stress reactions” and “preventing maladaptive stress reactions” (Department of the Army, 2006).
