Page 51 - Biobehavioral Resilence to Stress

28 Biobehavorial Resilience to Stress

The principles of PIES were followed throughout the Vietnam War,

during which time relatively few combat stress–related casualties were
reported. Although the principles of PIES were applied to great benefi t in

Vietnam, it is difficult to know how much of the apparently dramatic reduc-
tion in combat stress casualties in theater may have been due to the use of
drugs or alcohol as self-initiated strategies to cope with the stress of combat.

Most substance users in Vietnam discontinued substance abuse after the war.

However, some may have suffered more long-term psychological morbidity

as a result (Jones, 1995). There are few good statistics available to address the
overall incidence of psychological morbidity during the Vietnam War itself,
but Vietnam veterans were studied extensively many years aft er the war

ended. In fact, the long-term consequences of extreme stress first gained the

attention of researchers and the public shortly after the Vietnam War, when
it became clear that many service members were suff ering lasting eff ects of

trauma. Their symptoms often included fl ashbacks, hypervigilance, night
terrors, social isolation, amnesia, panic, and emotional numbing. Clinicians
described the syndrome as “posttraumatic stress disorder” (PTSD).
In 1980, PTSD was added to the American Psychiatric Association’s
Diagnostic Statistical Manual of Mental Disorders (DSM). Serious research
into the cause and treatment of PTSD began in the late 1980s. It eventually
became apparent that as many as 30% of all Vietnam veterans had expe-
rienced at least some symptoms of PTSD since their return from the war
(Kulka et al., 1990a,b). Considerable amounts of money have since been
invested in PTSD research and treatment (Shepard, 2001), the fi ndings of
which are well- represented in military and civilian scientific literature alike.

During the first Persian Gulf War (Operation Desert Shield/Storm,
1990–1991), immediate psychological casualties reported were few. How-

ever, in subsequent years, veterans of the first Gulf War have exhibited a
constellation of physical, psychological, and neuropsychological symptoms,
which is now most commonly described as “Gulf War syndrome.” It is not yet
known to what extent psychological trauma and exposure to chronic stress
may contribute to Gulf War syndrome (Riddle et al., 2003).
Medical planners for the current wars in Afghanistan and Iraq have
applied lessons learned from this past experience. In addition, psychiatric
epidemiologic principles are employed in an effort to quantify the psycho-

logical impact of war. Mental Health Advisory Teams (MHATs) are now
sent to each combat zone to survey service members and mental health pro-

viders. Th e first MHAT team survey (performed in Iraq in the fall of 2003
and published in the summer of 2004) documented that 77% of deployed
service members reported no stress or mild stress, 16% moderate stress,
and 7% severe stress. Surveys for specific diagnostic categories indicated

that 7.3% of respondents screened positive for anxiety, 6.9% for depression,
and 15.2% for traumatic stress. The overwhelming majority (83%) of those

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