8 - First Aid for Psychological Reactions
During actual combat, military operations continue around the clock, at a constant
pace, and often under severe weather conditions. Terrible things happen in combat.
During such periods the soldier’s mental and physical endurance will be pushed
to the limit. Psychological first aid will help sustain the soldier’s mental/physical
performance during normal activities, and especially during military operations
under extremely adverse conditions and in hostile environments.
8-1. Explanation of Term “Psychological
Psychological first aid is as natural and reasonable
as physical first aid and is just as familiar. When you were hurt as a child,
the understanding attitude of your parents did as much as the psychological effect
of a bandage or a disinfectant to ease the pain. Later, your disappointment or
grief was eased by supportive words from a friend. Certainly, taking a walk and
talking things out with a friend are familiar ways of dealing with an emotional
crisis. The same natural feelings that make us want to help a person who is injured
make us want to give a helping hand to a buddy who is upset. Psychological
first aid really means nothing more complicated than assisting people with
emotional distress whether it results from physical injury, disease, or excessive
stress. Emotional distress is not always as visible as a wound, a broken leg,
or a reaction to pain from physical damage. However, overexcitement, severe fear,
excessive worry, deep depression, misdirected irritability and anger are signs
that stress has reached the point of interfering with effective coping. The more
noticeable the symptoms become, the more urgent the need for you to be of help
and the more important it is for you to know HOW to help.
Importance of Psychological First Aid
First aid can be applied to stress
reactions of the mind as well as to physical injuries of the body. You must know
how to give psychological first aid to be able to help yourself, your buddies,
and your unit in order to keep performing the mission. Psychological first aid
measures are simple and easy to understand. Improvisation is in order, just as
it is in splinting a fracture. Your decision of what to do depends upon your ability
to observe the soldier and understand his needs. Time is on your side, and so
are the resources of the soldier you are helping. Making the best use of resources
requires ingenuity on your part. A stress reaction resulting in poor judgment
can cause injury or even death to yourself or others on the battlefield. It can
be even more dangerous if other persons are affected by the judgment of an emotionally
upset individual. If it is detected early enough, the affected soldier stands
a good chance of remaining in his unit as an effective member. If it is not detected
early and if the soldier becomes more and more emotionally upset, he may not only
be a threat to himself and to others, but he can also severely affect the morale
of the unit and jeopardize its mission.
Situations Requiring Psychological First Aid
aid (buddy aid) is most needed at the first sign that a soldier cannot perform
the mission because of emotional distress. Stress is inevitable in combat, in
hostage and terrorist situations, and in civilian disasters, such as floods, hurricanes,
tornadoes, industrial and aircraft catastrophes. Most emotional reactions to such
situations are temporary, and the person can still carry on with encouragement.
Painful or disruptive symptoms may last for minutes, hours, or a few days. However,
if the stress symptoms are seriously disabling, they may be psychologically contagious
and endanger not only the emotionally upset individual but also the entire unit.
In such situations, you may be working beside someone who cannot handle the impact
of disaster. Even when there is no immediate danger of physical injury, psychological
harm may occur. For instance, if a person is unable to function because of stress,
it may cause that person to lose confidence in himself. If self-confidence cannot
be restored, the person then may
become psychologically crippled for life.
Sometimes people continue to function well during the disastrous event, but suffer
from emotional scars which impair their job performance or quality of life at
a later time. Painful memories and dreams may recur for months and years and still
be considered a normal reaction. If the memories are so painful that the person
must avoid all situations which arouse these memories or if he becomes socially
withdrawn, or shows symptoms of anxiety, depression, or substance abuse, he needs
treatment. Experiences of police, firemen, emergency medical technicians, and
others who deal with disasters has proved that the routine application of psychological
first aid greatly reduces the likelihood of future serious post-traumatic stress
applying psychological first aid as self-aid and buddy aid
to all the participants, including those who have functioned well, is beneficial.
Interrelation of Psychological and Physical First Aid
aid should go hand in hand with physical first aid. The discovery of a physical
injury or cause for an inability to function does not rule out the possibility
of a psychological injury (or vice versa). A physical injury and the circumstances
surrounding it may actually cause an emotional injury that is potentially more
serious than the physical injury; both injuries need treatment. The person suffering
from pain, shock, fear of serious damage to his body, or fear of death does not
respond well to joking, indifference, or fearful-tearful attention. Fear and anxiety
may take as high a toll of the soldier’s strength as does the loss of blood.
Goals of Psychological First Aid
The goals of psychological first aid
Be supportive; assist the soldier in dealing with his stress
Prevent, and if necessary control, behavior harmful to him
and to others.
Return the soldier to duty as soon as possible after
dealing with the stress reaction.
Respect for Others’ Feelings
a. Accept the soldier you are trying
to help without censorship or ridicule. Accept his right to his own feelings.
Even though your feelings, beliefs, and behavior are different, DO NOT blame or
make light of him for the way he feels or acts. Your purpose is to help him in
this tough situation, not to be his critic. A person DOES NOT WANT to be upset
and worried; he would “snap out of it” if he could. When he seeks help, he needs
and expects consideration of his fears, not abrupt dismissal or accusations. You
may be impressed with the fact that you made it through in good condition. You
have no guarantee that the situation will not be reversed the next time.
Realize that people are the products of a wide variety of factors. All persons
DO NOT react the same way to the same situations. Each individual has complex
needs and motivations, both conscious and unconscious, that are uniquely his own.
Often, the "straw that breaks the camel’s back” the one thing that finally
causes the person to be overloaded by the stressful situation is not the stressor
itself, but some other problem. Thus, an injury or an emotional catastrophe will
have a personal meaning for each individual. Even though you may not share the
reactions or feelings of another person and even though the reactions seem foolish
or peculiar, you must realize that he feels as he does for a reason. You
can help him most by accepting this fact and by doing what you can for him during
this difficult time. He is doing the best he can under the circumstances. Your
positive assistance and trust may be what he needs to do better.
Emotional and Physical Disability
a. Accept emotional disability
as being just as real as physical disability. If a soldier’s ankle is seriously
sprained in a fall, no one (including the injured man himself) expects him to
run right away. A soldier’s emotions may be temporarily strained by the overwhelming
stress of more "blood and guts” than he can take or by a large-scale artillery
attack. DO NOT demand that he pull himself together immediately and carry on without
a break. Some individuals can pull themselves together immediately, but others
cannot. The person whose emotional stability has been disrupted has a disability
just as real as the
soldier who has sprained his ankle. There is an
unfortunate tendency in many people to regard as real only what they can see,
such as a wound, bleeding, or an X-ray of a diseased lung. Some people tend to
assume that damage involving a person’s mind and emotions is just imagined, that
he is not really sick or injured, and that he could overcome his trouble by using
his will power.
b. The terms "it’s all in your head, ” “snap out
of it, ” and “get control of yourself” are often used by people who believe they
are being helpful. Actually, these terms are expressions of hostility because
they show lack of understanding. They only emphasize weakness and inadequacy.
Such terms are of no use in psychological first aid. A psychological patient or
a physical patient with strong emotional reactions to his injury does not want
to feel as he does. He would like to be effective, but he is temporarily overcome
with either fear, anxiety, grief, guilt, or fatigue. He feels lost and unable
to control his emotions. Reminding him of his failure to act as others do only
makes him feel worse. What he needs is calm, positive encouragement, such as reminding
him that others have confidence in his ability to pull together and are also counting
on him. Often this reassurance combined with explicit instruction and encouragement
to do a simple, but useful task (that he knows how to do), will restore his effectiveness
Emotional Reaction to Injury
Every physically injured person has some
emotional reaction to the fact that he is injured.
a. A minor injury
such as a cut finger causes an emotional reaction in most people. It is normal
for an injured person to feel upset. The more severe the injury, the more insecure
and fearful he becomes, especially if the injury is to a body part which is highly
valued. For example, an injury to the eyes or the genitals, even though
relatively minor, is likely to be extremely upsetting. An injury to some other
part of the body may be especially disturbing to an individual for his own particular
reason. For example, an injury of the hand may be a terrifying blow to
a baseball pitcher or a pianist. A facial disfigurement may be especially threatening
to an actor.
b. An injured person always feels less secure, more anxious,
and more afraid not only because of what has happened to him but because of what
he imagines may happen as a result of his injury. This fear and insecurity may
cause him to be irritable, stubborn, or unreasonable. He also may seem uncooperative,
unnecessarily difficult, or even emotionally irrational. As you help him, always
keep in mind that such behavior has little or nothing to do with you personally.
He needs your patience, reassurance, encouragement and support. Even though he
seems disagreeable and ungrateful at first, ensure that he understands you want
to help him.
Emotional Reserve Strength of Distressed Soldiers
Realize that distressed
soldiers have far more strength than appears at first glance. An injured or sick
person may not put his best foot forward. The strong points of his personality
are likely to be hidden beneath his fear, anguish, and pain. It is easy to see
only his failures even though he worked efficiently beside you only a short time
ago. With your aid he will again become helpful. Whatever made him a good soldier,
rifleman, or buddy is still there; he is needed.
Battle Fatigue (and Other Combat Stress Reactions [CSR])
is a temporary emotional disorder or inability to function, experienced by a previously
normal soldier as a reaction to the overwhelming or cumulative stress of combat.
By definition, battle fatigue gets better with reassurance, rest, physical replenishment
and activities which restore confidence. Physical fatigue, or sleep loss, although
commonly present, is not necessary. All combat and combat support troops are likely
to feel battle fatigue under conditions of intense and/or prolonged stress. They
may even become battle fatigue casualties, unable to perform their mission roles
for hours or days. Other negative behaviors may be CSRs, but are not called battle
fatigue because they need other treatment than simple rest, replenishment and
restoration of confidence. These negative CSRs include drug and alcohol abuse,
committing atrocities against enemy prisoners and noncombatants, looting, desertion,
and self-inflicted wounds. These harmful CSRs can often be prevented by good psychological
first aid; however, if these negative actions occur, these persons may require
disciplinary action instead of reassurance and rest.
to Reactions to Stress