Battle Stress: Are We Prepared?

Battle Stress: Are We Prepared? by Captain Robert L. Maginnis “The ultimate limiting factor for the maintenance and endurance of organized and competent forces on the battlefield is man.” 1 The environment of combat creates a situation in which each man knows that at any moment he may be killed, a fact kept at the center of his attention by the sight of dead and wounded buddies. Each moment of combat thus adds to the accumulating stress that can become so great that almost any man will eventually break psychologically as the intensity and duration of exposure to combat continues. The conclusion is clear: battle stress casualties are as inevitable as gunshot and shell fragment wounds in warfare.* Battle stress has many symptoms: severe tremors, shaking, muteness, hallucinations, uncontrollable crying, hysterical (psychological) blindness, stupor and uncontrollable panic. These symptoms can be exacerbated by alcohol or drug reactions, pre-existing psychotic disorders, or be the result of injuries or wounds. The results are obvious and the victim becomes a liability te his unit. The Army’s Field Manual 26-2, “Management of Stress in Army Operations. ”delineates seven sources of battle stress3 0 Fatigue (fighting without sleep and rest). Mental stress (the need to be alert, evaluate situations, and make decisions in too little time). Low light levels (cause stress when more light is needed for performance). Battlefield demands (for example, operating in an NBC environment). 0 Isolation. 0 Adverse conditions. 0 Dayhight rhythm interruption. There may well be other ingredients to the battle stress equation. More research is necessary to identify these factors. The issue here is that battle stress is debilitating and the commander or leader cannot afford to neglect its impact.

Battle Stress and Past Wars History provides ample accounts of gallant actions by soldiers in combat. Their successes should be lauded, but the human costs which precipitated these successes are not always captured by the historian. Too often the spectacular results hide the costs in casualties to the troops involved. One seldom noted example of the hidden costs associated with victory occurred in September-November, 1944, during the Battle of Metz. In addition to its considerable losses in killed and wounded, the 5th Infantry Division experienced approximately 1,000 battle stress casualties (BSC). Fully 92 percent of these were members of the division’s three infantry regiments. (This amounted to approximately one BSC for every nine of the nearly 9,000 infantrymen.) One account of the battle indicates that the infantry soldier, constantly exposed to combat, ran a significantly higher risk of becoming a BSC than his peer in the november-december 1984 35

300 200 100 0 34th Division 300 200 100 0

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45th Division (Beebe and Debakey) Battle Stress Casualties Figure 1.

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combat support or combat service support units.‘ This experience suggests that battle stress is directly related to battle intensity. Evidence from another WW I1 battle also indicates that increases in BSC rates are directly related to combat intensity. In particular, the 6th Marine Division’s battle on Okinawa, 12 - 21 May 1945, attests to this relationship. During the battle, the Marines suffered 1,289 BSC. (The 1,289 BSC as a percent of the 2,662 WIA is 48.4%.)s Figure 1 displays the relationship between BSC and the density of WIA for the 34th and 45th Divisions during the Italian Campaign in the fall of 1943 and further supports the suggested correlation between BSC and battlefield intensity.6 During this period, the divisions were part of the VI Corps, 5th U.S. Army, participating in a sustained attack. The early October action was moderate and the late November action consisted of diversionary attacks as the 5th Army prepared to resume the offensive in early December.’ Figure 1 implies that the number of WIA increases in proportion to battle intensity. Correspondingly, battle stress casualties follow the WIA rate. The impact of psychiatric casualties is not intuitively obvious from a cursory study of the total U.S. casualties in WW 11. What the figures do not show is that the primary impact was at the level of the line company, battalion and regiment; units in direct combat. The overall rate for the Army during WW I1 was 101 per thousand BSC per annum. Interestingly, line regiments often suffered BSC rates as high as 1,600 per 1,000 per annum during the heavy engagements. (This statistic includes an unspecified number of multiple re-currences.)* Army Field Manual 26-2 indicates that overall U.S. Army stress casualties appeared at a relatively constant ratio of one stress casualty to between four and five WlA during WW I1 and Korea.9 Unfortunately, the manual presents this information in such a sanitized form that little inference can be drawn regarding the BSC relationship to battle intensity and duration. The examples of the impact of BSC in past wars are not alarming. We managed to cope. However, the current danger for Army planners (considering our announced doctrine) is the tendency to disregard stress casualties as an acceptable and treatable product of the next war. The risk here is that Army planners might come to this conclusion after reflecting upon personal experiences gleaned from the war in Vietnam. Vietnam is not a good battle stress model. Lest we forget, the Vietnam battle environment, according to Lieutenant Colonel Brian H. Chermol, USA, in his July 1983 Military Review article entitled “Psychiatric Casualties in Combat” noted these characteristics: 10 0 Low WIA and KIA. 0 A policy of restricted combat tours 0 Available rest and recuperation 0 Excellent support and supply sys- 0 Allied air superiority. 0 Low lethality and intensity of battle. 0 Brevity of most combat operations. 0 Rapid and dependable medical evacuation systems. 0 Mostly light infantry operations. These factors contributed to reducing the stress, fear, and fatigue commonly associated with previous wars. Fortunately, our Vietnam experience did not parallel the commonplace WW I1 experience of units such as the 4th Armored Division, which in September 1944 suffered 355 BSC.11 Those of 12 months. opportunities. tems. 36

ARMMP

At right, battk stress statlstks compiled by the Israeli Defence Force based on the experience of four battalions in the 1982 Lebanon fighting. Short, intense actions cause casualties to rise, the study concluded. BN

KIA/WIA

BSC

BSC as K BSC as $6 of WIA/KIA of Total Casualties 1 36 31 86% 46% 2 23 3 39% 28% 3 10 1 10% 10% 4 12 0 0% 0% Note: Ens are ranked from highest to lowest in terms of battle intensity. Figure 2. Battle Stress Casualties losses were attributed to the lack of many of the above-mentioned factors. In summary, the intent here has been to present several combat examples and the impact of battle stress. Several logical questions follow this discussion: 0 Should the U.S. Army base stress abatement policies upon the recent Vietnam experience? 0 Are WW I1 experiences still valid? 0 What about the Israeli experiences in 1973 and 1982? Do they apply to a future NATO/Warsaw Pact war? Just what is a valid reference point? The Israeli Experience The IDF has concluded that as conflicts become shorter, more intense and more fluid, the numbers of battle stress casualties emerge more rapidly. A case in point is the Yom Kippur War of 1973. The war lasted four weeks. Initially the fighting continued 24 hours a day. The revolution in warfare quickly became apparent: the war was very mobile and fluid. Closely coordinated multi-sourced firepower was constantly employed and casualties grew in proportion to the battle intensity. The end result in terms of BSC reveals an interesting story. The IDF experienced 30:lOO ratio of BSC to non-fatal casualties. Their highest stress losses occurred during the Suez crossing when artillery and rocket fire was most intense.12 The IDF experience in Lebanon during June-December 1982 resulted in 600 BSC, or a 23:lOO ratio of psychological casualties to WIA.13 However, the limited nature of this conflict does not present an accurate account of the battle stress impact. An IDF study of four battalions during the Lebanese war better illustrates the seriousness of battle stress. The IDF ranked the four separate battles in which these battalions were engaged in terms of battle intensity. The intensity judgements were based upon expert ratings concerning preparation (enemy location, mission, false alarms); battle (field artillery, air attack, ambush and minefields) ; support (tactical, logistical and material); enemy resistance (strong, adequate, weak); trust by the commander in his higher command (unjustified pressure, some pressure, adequate support). These casualties seem to support the case for correlating battlefield intensity with increased BSC rates. This certainly reinforces the evidence from the 6th Marine Division’s Okinawa experience. The IDF also found (as a result of their past wars) that reservists tend to be more vulnerable to battle stress than active duty soldiers, and support units more than combat troops. The results of the Israeli combat experiences are clear: 0 Modern warfare will be continu-Modern weapons are more lethal. Casualty rates increase with inten-Battle stress is a serious problem. Doctrinal Implications If, based upon the IDF’s recent experience and a few past American experiences, we accept that stress is a serious problem and will play a significant role in any future war, then we ought to look at the issue of how we anticipate fighting, surviving and winning on the future battlefield. Army FM 100-5, “Operations, “portrays the Warsaw Pact (WP) doctrine as characterized by rapid advance, deep penetration, relentless attacks and bypassing strong points.*s Army studies show that the WP forces outnumber ous. sity.

NATO forces five-to-one in armor, four-to-one in artillery and three-to-one in combat aircraft. Couple this with a perceived WP willingness to use large and available inventories of chemical and nuclear munitions and we justifiably foresee a formidable foe for any future European scenario. FM 100-5 describes this future battlefield in terms of: non-linear maneuver battles, lethal systems and instant intelligence. The battle will include the use of chemical and nuclear weapons to alter the balance of power and increase the tempo. Electronic countermeasures will segment and confuse our forces, requiring subordinate commanders to take the initiative. The air war will be in depth and rear areas will be threatened with airmobile and airborne forces and long range fires.16 Put together with Soviet doctrine we can anticipate something coined as continuous operations. This is a new concept of “modern warfare that is made possible by the almost complete mechanization of land combat forces and by the technology that enables effective movement and combat at night, in poor weather and under low visibility conditions. ”17 A war between NATO and the WP translated into human factors means: high lethality, high disability, high stress, significant casualties in the rear areas, severe sleep deprivation, low light levels and operations during normal sleeping hours.18 According to FM 26-2, this translates into a ratio of at least one BSC for every three WIA. (This article will not provide a parallel projection concerning the possible impact of battle stress on WP armies. This deletion should not be interpreted to mean that the impact will be unilateral. We expect the WP to sustain significant BSC as a result of their execution of a doctrine of deep penetration, november-december 1984 37 sustained attacks and massive use of extremely- lethal systems. The impact of battle stress on WP forces should not, however, be as debilitating due to their shorter support lines and significant reinforcement capability. We might also note the presence of a political officer in each unit. This individual is armed with psychological tools of persuasion without parallel in our force and has the potential to remedy stress-producing situations.) An Approach to Battle Stress Reconstitution programs typically contain three categories of measures: dissipatory, compensatory and anticipatory. Dissipatory measures are the traditional means of addressing the impact of stress for combatants: provide creature comforts, religious services, provide sufficient and effective fire support, and rotate units out of the front for periods of rest.19 Compensatory measures are designed to reduce stress associated with intense exposure to the rigors of combat during the battle: simplication of equipment, time limits in the war zone, rest and recuperation, ready availability of medical treatment? Anticipatory measures are used to reduce battle stress casualties by proper actions taken before the battle: physical and psychological conditions, selection of leaders who are best suited for each role, unit esprit de corps, discipline, education and skills for coping with stress.21 If we plan for a high-intensity short-duration war in Europe, then Army reconstitution measures (dissipatory and compensatory) will be too late or prohibitively expensive and will have a negligible impact on abating stress on a future battlefield. It would thus appear that future war in Europe will place the primary burden for coping with the problem of combat-induced stress on the respective battlefield commanders and their staff rather than any one program of reconstitution.22 The interim solution seems to be in terms of anticipatory measures. At present, Army leaders are not equipped with the training and experience to manage the levels of stress anticipated. Two alternative actions appear to address this deficiency: One is to provide sufficient training to all Army leaders to enable them to understand stress, its impact, and how to cope with and treat organizational and individual victims. Another is to assign specially trained personnel to each unit likely to be affected. A precedent for the utility of leader training as a stress abatement function is provided by the IDF. After the 1973 Arab-Israeli War, the IDF conducted scientific appraisals of morale, leadership, unit cohesion, and their relationship to combat effectiveness. It concluded that pre-combat unit morale and readiness are highly correlated wit h:23 0 Trust in the unit commander. Unit functioning during combat. 0 Unit morale in combat. 0 Self-appraisal as a soldier. The “key” to unit morale seems to be the effectiveness of the unit commander in projecting himself and preparing his unit. The IDF submits that units with high trust in the commander also had high morale which together sustained the unit as it went into combat. The IDF defines trust in the commander in terms of competence. Trust was earned by24 belief in the professional competence of the commander, belief in the credibility of the commander, and the soldier’s perception of how caring the commander is. The study also indicated the commander’s professional competency becomes the primary ingredient of trust in combat. The IDF defines professional competence in terms of what the 38 commander does in combat. His critical combat behaviors are redefined in terms of specific measurable competencies. Those competencies are: assertiveness, decisiveness, ability to delegate, ability to develop subordinates, self-confidence, influence, judgment, ability to plan and organize, positive expectations, willingness to take initiative, ability to develop teamwork, technical proficiency, tolerance for stress and effective use of resources. These competencies were instrumental in creating the perception of professional competence. Soldier perception, according to the IDF, correlates most highly with combat effectiveness. This list looks suspiciously like a competency-based model for a company-level commander.zs This discussion is especially relevant because BSC are statistically less prevalent in units with high morale. Commanders (leaders) who have the critical competencies and content expertise play the key role in the process of unit effectiveness, and thus stress abatement. The second alternative action is to provide a staff member (to each battalion) who has sufficient training and experience to assist and train the commander and his subordinate leaders. This key officer would act as an organizational psychologist. His patient is the unit and its members. His job would be to train all leaders in accordance with the intent of the first alternative. Additionally, he would act as an advisor to the commander to help with decisions concerning movement and placement of units and the retention or replacement of leaders. (This could be a special course for prospective executive officers. A seventeen-week specialized course for prospective XOs would cost in OMA and MPA dollars approximately $1,542,000 annually. The estimate is based upon a course similar in resource requirements to the Armor Officer Advanced Course. The estimate also includes the addition of 17 personnel to an existing staff.P The importance of a person trained to identify the stress symptoms and the impact of stress is critical to unit effectiveness. A case in point was the Cuban Missile Crisis. Recently declassified materials indicate that if President Kennedy had gone with his first inclination, as he was advised, a serious situation might have been resolved in a very different manner. (The initial advice was to bomb Cuban missile sites.) Presidents, generals and field commanders must be perpared to face important (time sensitive) decision situations permeated with stress. They Personnel policies and the nature of the conflict helped keep battle stress casualties relatively low during most of the Vietnam fighting. But the stress of combat clearly shows in the picture above. require the ability to make sound decisions despite the impairing consequences of stress. The proposed XO would be on hand to help the commander consider his decision in terms of the pressures. This offcer would also conduct and supervise the periodic training and checks required for sustainment of the stress abatement program. Using a “stress test”, he might provide subordinate leaders and his boss with accurate measures of how they are doing. Even more important, how are they preparing the unit for combat? Preparing the Army to Cope Army preparations should include the ongoing dissipatory and compensatory programs as well as increased emphasis on anticipatory measures.

Specifically, the Army should realize the best return for the tax dollar from a three way investment in stress abatement training. The IDF’s study (in the previous section) suggests that properly trained units are more effective in combat and suffer fewer BSC. The recommended programs complement an ongoing effective unit combat training effort: Leadership development: There are sets of leader competencies (skills, traits, characteristics) which discriminate between the outstanding and average combat leader. The identification and subsequent training of these competencies will significantly enhance Army combat leader effectiveness. (The scope of this article precludes a full discussion of available competency-based models, their origin and deve-november-december 1984 39

1opment.P Leader Evaluation: If we are to focus the leadership community on the reinforcement of combat correlated leader competencies, we must tie this effort to an ongoing evaluation process. The first step is the alteration of current personnel evaluation instruments. The alterations will permit specific competency oriented (by role) evaluations. Stress Management i n Army Units: Army leaders should participate in practical exercises which improve their ability to manage levels of stress. Leaders need to view stress in terms of a unit program rather than unrelated individual problems. Some of the skills should include psychological preparation for combat, the relationship of “proper” physical conditioning to stress coping, the costs and benefits of rest and relaxation in combat and how to make this happen. Leaders should learn how to reintegrate treated and returned BSC, how to implement a buddy system in a unit, how to insure proper lateral and vertical communication to quench rumors and bolster stress abatement efforts, how to analyze leadership effectiveness prior to and during combat, how to gauge unit morale, confidence and will to fight prior to combat and what to do if problems surface. They must know how to ensure cohesion in a turbulent environment. What should leaders do at different organizational levels? A number of cohesion models are currently available. One of the most recent was developed by CPT (PI Dan Braun.28 Conclusion The Army recently published material concerning the frequently overlooked subject of battle stress. The material provides a starting point for a major effort to focus attention on how best to reduce the possible catastrophic impact battle stress could have on American units in a future high intensity war. If we accept the supposition that a future high intensity war has no reference point in our past, then the battle stress problem takes on a disturbing dimension. (Even recent Israeli combat experiences provide only a few clues concerning the probable impact of battle stress on unit effectiveness.) What, then, should be our reference point for stress abatement plans? Should we choose a combination of dissipatory (creature comforts, rotation of units out of the front), compensatory (simplification of equipment, ready availability of medical treatment), and anticipatory (physical and psychological conditioning, education, leader selection) measures? Where do we invest our limited resources to best prepare units to cope with the psychologically debilitating stress associated with the future battlefield? This article makes a case for a balanced stress abatement program of dissipatory, compensatory and anticipatory measures. The demonstrated high payoff potential of anticipatory measures received special emphasis. Specifically, the article suggests that competency-based leader training can make the difference as we prepare for the high-intensity battlefield. Leaders Footnotes 1 Appel, J.W. and Beebe, G.W. Preventive fsy-chiarry, J.A.M.A. 131 18 1946. Walter Reed Institute of Research, Cohesion, Anticipated Breakdown, and Endurance in Battle: Consideration for Severe and High Intensiw Combat, by David H. Marlowe, p.l. U.S. Army Soldier Support Center, Management of Stress in Army Opemtions (FM 26-2). prepared by Applied Psychological Services, Inc. Wayne, PA, Dec 1983, pp. 12-13. Marlowe, p.4. Ibid.p.6. 6 Ibid, p. 7. Oflice of the Chief of Military History, The Mediterranean Theater of Operations: Salerno to Cauino, by Martin Blumenson, June 1967. 8 Marlowe, p. 5. 9 Applied Psychological Services, p. 19. 10 Cherrnol, B.H., “Psychiatric Casualties in Combat, Militav Review, ”pp. 26-32, July 1983, p. 21. 11 Marlowe, p. 5. l2 Walter Reed Army Institute of Research, Israeli Battle Shock Cmlties: 1973 and 1982. by G.L. Belenky. C.F. Tyner andF.J. Sodetz, August

1983. p. 2. l 3 Ibid, p. 11. 14 Ibid, p. 33. ‘5 Department of the Army, Operations (FM l6 Ibid. l7 Applied Psychological Services, p. 2. 18 Ibid.p.2. 19 U.S. Army Logistics Center, farrl, BDMFin- a1 Report, New Approaches to Reconstitution in High Intensiw Conflict on the Modem Battlefield, prepared by BDM Corp, Mclean, VA, Contract BDM/W-79- 100-5).20 Aug 1982. SW-TR, 14 Mar 1980. p. VI 18. 2o Ibid, p. VI 16. 21 Ibid, p. VI 13 -VI IS. 22 Belenky, p. 21. 23 Ibid, p. 21. z4 Ibid, p. 21. 25 Maginnis, Robert L., Company Commander Competency Assessment for the United States Army, (master’s thesis,) Naval Postgraduate School, Monterey, CA, 1983. 26 Costing estimates provided by TRADOC Comptroller, Ft. Monroe, VA, Nov 1983. (This is based upon a 300-student annual population at an exisiting TRADOC school). 2’ Maginnis, Chapter 2. 28 Braun, Daniel G.. Cohesios A New Perspec-the, master’s thesis, Naval Postgraduate School, Monterey, CA, 1983. trained in critical combat competencies, coupled with stress-abating skills, can significantly reduce the impact of battle stress on unit effectiveness. This relatively inexpensive alternative emphasizes the human multiplier which is frequently neglected by military analysts. The analyst projects the confrontation of forces and extrapo-lates outcomes without incorporating a basic qualifying ingredient, leader effectiveness and unit morale. The Israelis label unit morale and leader effectiveness as their “secret weapon.” Israeli combat experiences indicate that units with this “secret weapon” experience fewer BSC and are generally more combat effective. For this reason (and others) it is recommended that U.S. funds earmarked for stress abatement programs be invested in programs which train leaders and their units to cope with significant levels of stress. This investment will ultimately pay dividends in terms of unit effectiveness and fewer BSC. This translates into an investment in America’s own “secret weapon” - the American soldier.

CAPTAIN ROBERT L. MA-

GlNNlS was commissioned in Infantry from the USMA in

1973. H e has served as a company XO and a s rifle and mortar platoon leader with the 2d Infantry Division and as a mortar and TOW platoon leader and assistant S3 in the 1st Infantry Division. He is a graduate of the Field Artillery Officer’s Advanced Course and has served on t h e G 3 training staff and a s a company commander in the 8th Infantry Division. He holds a masters degree in management from the Naval Postgraduate School, 1983. He is currently a leadership instructor at t h e Infantry School, Ft. Benning, GA. 40