Page 49 - Biobehavioral Resilence to Stress

26 Biobehavorial Resilience to Stress

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)

Introduction

The goal of this chapter is to address the current status and practice of mili-
tary 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 specifically to vulnerability or resilience to stress. Here, we
defi ne resilience as the ability to adjust easily to stress or to recover quickly

and effectively 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).

The explicit goal of current military mental and behavioral health policy
and practice is to maintain individual and unit readiness (i.e., the ability to

fi ght effectively in the near term and on short notice). By design, current
strategies focus on prevention as well as management of stress reactions that
could have a negative impact upon behavior or performance. For example,
when stress interferes with concentration and attention, service members

may find it difficult or impossible to perform any of the military mission–

relevant tasks. Military mental health providers often measure success by

tracking “return to duty” rates for service members who present as potential
casualties of combat-related stress.
Individual readiness is determined by the commander’s or the doctor’s
assessment of each combatant’s ability to perform basic and specifi c job-
related tasks. An entire military unit may be deemed “combat ineff ective”
if less than 85% of its member personnel are unavailable for active duty due
to death, injury, or debilitating reactions to stress. Many reactions to stress
are potentially preventable or treatable. In order to ensure combat eff ective-
ness for military units, it is important for commanders and clinicians to
recognize and address any circumstances or diffi culties that might cause or
increase casualties of combat-related stress.
We begin this chapter with a brief history of combat psychiatry. Our
purpose is to provide historical context for the emergence and development
of current interventions. We then consider the current issues relevant to the
prevention, management, and treatment of combat stress throughout the

cycle of military deployment. Then the management of stress-related disor-
ders in the theater of operations is discussed, and this chapter is concluded

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