25 December 2008

http://www.marines.mil/news/publications/Documents/Combat%20Stress.pdf (30pp, 3.2MB)

COMBAT STRESS

A Concept for Dealing with the Human Dimension in Urban Conflict

PCN 145 00000 400

DISTRIBUTION STATEMENT A: Approved for public release; distribution is unlimited.

United States Marine Corps
Deputy Commandant for
Combat Development and Integration

16 May 07

Foreword

During times of conflict, we as leaders are reminded of both the importance of military proficiency and in the related need to take care of our Marines. Taking care of the Marines not only includes the proper treatment of the physical injuries associated with combat, but it also involves dealing with the mental injuries which can result from combat—especially in the difficult form of irregular warfare we are seeing in today’s urban conflict environments. This concept is aimed towards Marine leaders of all grades. My intent is that leaders would use it as a tool for teaching and professional discussion. While this concept is appropriate to use anytime, I recommend that leaders use it as a part of our pre-deployment preparations. While we are honing the skills among our units to make us successful in combat, we need to take the chance to re-emphasize the mind and body connection, and work to precondition our Marines for the challenges that they will inevitably face. This concept is not intended to be clinical in nature, but rather an easily digestible, straight-forward approach that leaders can apply before, during, and after combat operations. The nature of the current conflict makes this subject especially relevant.

JAMES F. AMOS
Lieutenant General
Deputy Commandant for Combat Development and Integration

We few, we happy few, we band of brothers;
For he today that sheds his blood with me
Shall be my brother.

-- King Henry V from William Shakespeare’s play, King Henry V (Act IV)

Introduction

This concept pamphlet is aimed at helping leaders see with greater clarity the unique challenges in the human dimension of working in the difficult environment of urban conflict and at assisting leaders in the operating forces to prepare their Marines for these challenges. From the standpoint of force development, the intent of this concept is to keep the focus on setting the conditions in advance of combat operations so that our Marines are always ready when they enter harm’s way. In the long run, attention to the issues addressed in this concept will help the Marine Corps to sustain the transformation that begins with basic training, producing more combat resilient Marines who go on ultimately to become more productive citizens once they leave the ranks.

In this concept we introduce some of the environmental challenges and their link to operational stress. We discuss the human side of Marines, in particular the role of unit cohesion and the importance of intense training to prepare Marines for the tough environment that they may encounter. Individual and unit morale are directly linked to the ability of Marines to tolerate operational stress. We discuss the leader’s role in maintaining high morale in combat, to include understanding the mind-body connection, the “social contract” between leaders and their Marines, and the formation of a “muscle memory” of a Marine’s moral code. Finally, we discuss the leader’s role in recognizing and identifying the signs of Marines suffering from operational distress.

The Environment

Operations in urban areas are perhaps the greatest test of a small unit leader’s human skills. Circumstances surrounding today’s urban operations involve many factors that may contribute to psychological distress:

• Rapid turnaround and redeployment.

• Terrorist tactics.

• Restrictions on fire power to prevent killing innocent civilians.

• Continuing conflict with slow progress—requiring patience.

• Frustration that locals are helping the enemy.

• Rules of engagement generally prohibit employing deadly force until hostile intent is detected.

• Developing a sense of disdain for local citizens of less developed countries.

• Commission of intentional atrocities by the enemy.

• Local civilian population perceived by Marines as hostile.

• Sense of isolation if cohesive, well-trained units are not deployed.

• Snipers.

• Dismay over enemy violations of the law of war.

• Urban terrain reduces effectiveness of US technical superiority.

The reality of fighting in urban terrain is that units will have to operate with less direct support and with less senior leadership oversight in areas that resemble an extremely complex maze. The stresses are unique and often extremely demanding. The characteristics of urban operations lead to great complexity—which for the man on the ground makes for uncertainty and a distinctive form of mental stress. Urban conflict takes place in a “morally bruising” environment. This makes the role of the small unit leader a critical factor in both the success of the mission and a critical factor in protecting the psychological health of his Marines. Just as the leader trains his Marines hard to prepare them for combat, he must also take a proactive approach to developing psychological resilience in his Marines. The three dimensional nature of urban conflict with innumerable fields of fire, poor concealment for troops moving through the area, close quarters fighting, command and control challenges, and restrictive rules of engagement due to the presence of civilians in large numbers, all serve to create a chaotic and often confusing situation.

It is the responsibility of the small unit leader to ensure that his Marines are physically and psychologically ready for this test. Experience from previous wars shows that psychological distress associated with combat operations played a significant role in lowering the combat effectiveness of units. The small unit leader is in a position to be able to recognize the early warning signs of distress and take action. It does not take specialized training and degrees in mental health for leaders to enhance the ability of their Marines to respond effectively in urban fighting and increase their resilience to combat stress. A US Army mental health study of Operation IRAQI FREEDOM found that Soldiers who rated their noncommissioned officers (NCOs) highly were significantly less likely to have problems related to operational stress (such as depression or anxiety). The reality is that good small unit leadership “protects” Marines’ mental health from the effects of combat exposure. The following are hallmarks² of combat exposure. The following are hallmarks to look for in a unit that will stand up well against the stress of urban conflict:

• Cohesion—a manpower system built on trust.

• Repetitive, realistic training.

• Tight bonds between leaders and those being led—including shared privation and danger.

• Leaders inspire affection, trust, and confidence in their Marines.

• Leaders are ever present and senior leaders practice “battlefield circulation.”

• Marines display loyal obedience to their leaders—even when their leaders are not present.

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2 Most of these hallmarks are adapted from the writings of Dr. Jonathan Shay.

Human Dimensions of Urban Conflict

Large-scale force-on-force maneuvers in open or semi-rural areas are normally more focused on equipment, weapons, and munitions. However, conflict in urban areas takes on an intensely personal character—intimate killing and there are no forward or rear areas. Danger can come from the most unexpected directions and in the least anticipated forms. Marines know they are being watched—perhaps by an enemy in hiding. This danger seems strange when it exists among civilian non-combatants. An alleyway may appear to be simply what it is—not a field of fire for insurgents to launch rocket-propelled grenades. A hospital may be a place to treat people who are ill or injured, but it may also be an enemy assembly area. The unpredictable nature of many of the current urban areas of conflict can seem very disturbing and contribute to operational stress.

Marines may tend, based on their training, to see problems in urban areas in simplistic, military-only terms. The local people can become almost invisible to them—as if they are merely part of the scenery or terrain. Marines may become frustrated with the behavior of local people when they “get in the way” of military operations, or worse, are suspected of helping the enemy. A mounted patrol transiting the main streets of a city can become bogged down in traffic along with the civilian vehicles. People seem to be everywhere and Marines cannot tell which ones are sympathetic, which ones are helping the enemy, and which ones just want to go to work or to market. Uncertainty often leads to confusion and frustration. Marines want to be able to distinguish between the “good guys” and the “bad guys.” When it is impossible to discern the difference between the enemy and the good guys, some Marines may become angry and disillusioned with the mission, or even racially prejudiced in their response to these frustrations. This anger and disillusionment can make for its own form of psychological stress. Leaders must “image” with their Marines about this challenging environment before the Marines experience it themselves so that they will know what to expect, understand it better, and respond effectively. This process of building a mental image of anticipated future environments and events—and then “walking the Marines through it”—is invaluable in terms of mental and physical preparation.

In urban operations, Marines may have difficulty dealing well with the local people. However, interacting with the local people on a regular, sustained, and meaningful level is exactly what they should do. Contact with locals can, at times, be quite frustrating, but we should remember that, for the most part, the citizens just want to be left alone to go about their daily lives. They did not choose to have combat in their backyard, but in order to survive they may be less than frank. Marines may interpret this as a sign that they are aiding the enemy and perhaps the local people are helping the enemy indirectly. This perceived duplicity can increase the psychological stress your men experience. Marines in this situation cannot afford to lose their humanity—they need to share their courage with the local people.

Cohesion

Military operations in urban terrain begins long before arrival in the combat zone. Marines look forward to the opportunity to prove themselves in combat. They joined the Marine Corps expecting action, and therefore, deployments and combat action generally do not adversely affect morale. In fact, unit cohesion and morale often improve prior to and during a deployment to combat. Marines thrive on being part of an elite team with a support system that can only come from the interpersonal relationships they develop with other Marines—the camaraderie, such as is found in all well-led units.

This camaraderie must begin the moment a Marine joins a unit. Every Marine new to a unit must be welcomed and develop a sense of belonging in the unit. Marines should be kept together in their cohort as much as possible. That is not to say that these Marines will not face the same trials as the others, only that they have better relational support available in order to deal with the challenges. Leaders need to ensure that the cohesion is “unit cohesion” and not a clique. Closely knit groups within the unit that exclude some of the unit members are damaging to the overall morale and may interfere with accomplishment of the mission. People who separate themselves apart from the unit are at higher risk for misconduct. Conversely, people in cliques may be excluding other Marines who won’t go along with the group mentality. The “voice of reason” may be missing. Feeling “different” or “special” could lead them to believe that rules do not apply to them. The small unit leader is responsible to ensure that each of his Marines is integrated into the unit in a manner that instills pride and commitment to the unit and the mission. The bond Marines build in a strong unit actually helps to “inoculate” them against combat stress. Operations in urban areas demand that Marines have trust and faith in all other members of the unit. Urban patrols by nature involve smaller groups of Marines. The leader needs to ensure that each Marine can count on any other Marine in the unit. Lack of trust will cause psychological distress for even the most confident and capable Marine.

Leaders can do numerous things prior to deployment to prepare their Marines for the tough challenges ahead. Marines need to know that our history as a Corps has many examples of Marine units working successfully in the difficult environment of urban combat. Marines should know that we have performed this mission before—and with great success. Also, unit leaders would do well to bring “mental fitness” experts in as part of the pre-deployment training. A major role of the military mental health professional is preventive “mental fitness” training. Leaders can mentally prepare the Marines by providing quality “stress inoculation” training from mental health professionals who are capable of helping.

Tough, Realistic Training

Past experience has proven that tough, realistic training reinforces positive morale. Marines who know that they are well trained for their mission are more confident and less likely to be affected by combat stress. Training must be continuous while deployed to combat. In present day urban combat, enemy tactics change rapidly. A training mindset must be adopted in which the Marines are constantly innovating and adapting their tactics and skills. This learning culture builds esprit de corps and psychological resilience.

In this tough realistic training, leaders want Marines to learn certain things so well, that they don’t actually have to think about the action at their conscious level—they just do it. Leaders often refer to this as “muscle memory.” However, Marines who are involved in protracted urban operations will find it tough to avoid complacency. Every day may start to feel like the previous one and Marines can begin to lose their edge. Training must also include exercises that create the “thinking man.” Marines must maintain their offensive mindset, even in simple daily operations. That offensive mindset translates to being the hunter and not the hunted. If troops start to feel like they are the ones being hunted, this sensation can hurt morale and lead to psychological stress. Even simple measures like an aggressive use of guardian angels³ can preserve the hunter instinct. Marine leaders need to coach their people in the development and vigilant maintenance of the hunter instinct. All hands after action reviews (AARs) during which each Sailor and Marine contribute to the discussion can also breed “ownership” for unit and individual improvement.

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3 Guardian angels refers to an overwatch Marine in a hidden/ambush position; not a guard in the open who is visible to the enemy.

Know Your Battleground

Perhaps it would be easier for Americans if all of our conflicts occurred in places with cultures very similar to our own. The reality is that most conflicts take place among people whose culture is quite different from our Western perspective and can be tough for Marines to understand. A leader’s responsibility is to teach Marines about local culture in the combat zone. This does not mean that Marines need to take on native customs or become fluent in their language, but it does require Marines to adopt a different approach, one that shows respect for the local people and their culture. The extent to which Marines can develop some level of understanding for the circumstances of local people will often define how successful Marines will be in performing their mission. Marines must demonstrate in word and deed that they do not regard themselves as being superior to those in the local area. Marines must remain professional and show that their concern is genuine, creating human bonds that will defeat the enemy’s efforts to undercut our mission accomplishment. In most cultures in which Marines will be working, human relationships mean more than words on paper or formal contracts. A handshake followed by a cup of tea may be the best way to propel an agreement forward. Understanding the local culture will help Marines to not personalize some of the behaviors that seem very contrary to a Western view of right and wrong.

Achieving High Morale

Proactive leaders can find numerous ways to maintain unit morale in urban combat. As simple as it sounds, attending to some basic creature comforts, as they become available, can remarkably improve morale. Ensuring inbound mail is delivered in a timely fashion, looking for ways for Marines to contact family back at home occasionally, scheduling decompression or “down time” and active recreation events (such as a pick-up game of tag football or softball). Marines will appreciate the chance to eat a good hot meal, take a shower and put on a clean uniform. When a leader makes the effort to take care of his Marines, he is demonstrating that he cares about the human inside the uniform.

Another way to enhance morale is to ensure active “buddy involvement.” The measure of a good leader is how he treats the poor performer. No matter how well Marines are trained, they can’t all be the best. A leader has to teach his Marines that “it takes all of us to make a team.” In urban conflict with smaller teams and the potential for casualties, the Marine who was struggling to keep up could be the one who saves a life. If the leader treats every one of his Marines as if he was the one who might some day save a life, the leader can develop true unit-wide esprit de corps. If the leader demonstrates this kind of positive leadership, the entire unit is more likely to live up to high expectations. Be the kind of leader to whom people say, “I’d gladly follow him into combat.”

Marine leaders should also know a good deal about the history of their Marines and their goals (especially social, educational, physical, financial, careers). The leader needs to know which Marines have deployed to combat before and how many times. Leaders can’t just say “Marines deploy, that’s what we do.” However, remember that previous deployments may have also provided Marines with valuable survival and tactical experience.

The Body-Mind Connection

Marine leaders need to be knowledgeable about the body-mind connection during combat and in preparation for combat. We know that all animals have a fight-or-flight response when faced with a threat. This is completely normal and adaptive for our survival. Imagine that you were chased by a tiger and you were able to escape up into a tree. If the tiger got bored after a while and wandered off, would it make any sense for you to immediately come down out of the tree? No. That would make no sense for your survival. You would hang out in the hyper-vigilant state for much longer than you had to. And when you did start to come down, you would come down really slow because if the tiger came back you wouldn’t have as far back up to go. So it would have no survival value for you to be calm and relaxed just because you aren’t being shot at right now. And when you get on a plane and fly back to the United States, you won’t immediately “come down out of the tree.” It will be a gradual process. However, if you find that the problem continues and does not appear to be improving, it would be a good idea to see your chaplain or a mental health professional for help. Although this hyper-alert state is common, if it persists, it can be an indication that you need some help dealing with the operational stress you have experienced.

The leader needs to ensure that his Marines learn how to “downshift”⁴ in healthy ways to prevent the build up of disabling stress. Establishing a new post-deployment routine that includes a healthy diet, regular sleep routine, productive work, and challenging physical training is a good way to are also very positive. Marines should avoid immediately breaking away from their buddies and going in their own direction. Marines “decompress” best as a group. Sharing examples of Marines who came home from Iwo Jima and other such tough fights can remind them that others came through similar events and came out fine.

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4 “Downshifting” concept developed by Dr. B.A. Dexter CDR, USN

During deployment, when on patrol in an urban area, it is normal for Marines to be at a heightened state of alertness. The brain and body work together to produce the bio-chemicals that help in the state of “fight or flight.” But if the stress biochemistry is always turned on, it is as if liquid were poured onto a wooden floor. The liquid might seep through cracks in the floor and out of sight for a while, but it will eventually rot the foundation.

On the other hand, if a Marine experiences stress and can do something with the “fight or flight” bio-chemistry he can actually become more resilient. Not unlike lifting weights, when lifting heavier weights than before, some muscle tissue is torn down. But when allowing the body adequate rest and recovery, it becomes stronger than before. The same thing happens with psychological stress. Encourage the Marines to talk about things that are on their minds to allow them to “dissipate” some of that stress, recover, and become more resilient. Effective leaders can create a climate where Marines speak up when they need to without breaking down good order and discipline. At the same time, leaders need to be sensitive to what their Marines are experiencing and how they are reacting to the stress. Some Marines will not be ready to talk about an experience immediately after the event—when they are still in a state of mental confusion. Timing is the key.

Placing a priority on maintaining physical fitness will reinforce morale and help Marines deal with the effects of combat stress. Vigorous exercise, especially intense fitness training that aligns with combat function, reinforces the Marine’s ability to deal with psychological stress. Exercise helps your men to “downshift” so they can actually get good quality rest when they have time to rest.

Chronic fatigue brought on by interrupted sleep, irregular sleep cycles, and prolonged operational stress can interfere with the best laid plans. It may be unrealistic to expect that Marines will be able to get long periods of sleep during extended urban operations. However, a leader must ensure that his men are trained in “mental fitness” skills that help them learn to be able to fall asleep quicker and to stay asleep for as long as they safely can. There is no substitute for adequate sleep. This is one of the areas where a leader should bring in local mental health professionals as part of the training team. Sleep research has clearly shown that even if you can’t sleep for one good block of time, if you can sleep at approximately the same times of the day regularly, you will feel better and perform better. A leader must pay attention to details that may result in mistakes or accidents resulting from sleep deprivation. Some sleep deprivation problems are as follows:

• Ability to problem solve—one of the first capacities to be affected.

• Impairs the ability to be vigilant.

• Impairs physical performance.

• Affects mood, contributing to irritability, excess worry, and depression.

An additional benefit of longer periods of uninterrupted sleep is that it allows the person to experience longer periods of rapid eye movement (REM) sleep—that stage of sleep where the brain gets more of its emotional rest. REM sleep is where most dreams occur—but sleep experts advise, “Don’t try to ‘interpret’ dreams.” Sleep laboratory research has shown that theories of “dream interpretation” have no scientific validity. It is well known that normal, nonviolent law enforcement personnel and men returning from combat have dreams that mix aggressive content with other parts of the person’s life.

Sleep experts comment, “Violent dreams do not produce violent behavior, it is the other way around. When someone has a disturbing experience they will have “disturbing” content in their dreams. Look at those dreams as the brain’s way of resolving unsettling experiences by linking it to some part of their life that is not disturbing. Dreams “neutralize” the distressing material.”⁵

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5 Dr. B.A. Dexter, CDR, USN

A word of caution here: if Marines are having re-occurring nightmares that wake them up in the middle of the night, such as sweating or feeling confused with their heart racing, they may be showing the early signs of stress injury and probably need to seek help from a mental health professional.

Pay Attention to the Social Contract

The “social contract” refers to the unspoken, unwritten, but understood agreements between us and other people and between us and organizations. It is the stuff that is supposed to happen and you aren’t supposed to have to tell people to do it. It is social glue. Violations of the social contract occur when Marines do not get equipment they feel they need, when they believe they are not getting adequate information, when they do not get recognized for their accomplishments, when someone at home lets them down, and more. The extremely complex nature of urban conflict can actually cause violations of the social contract even in the best of units. It is critical that leaders become aware of situations that could cause such violations and work to prevent or repair them.

Violations of the social contract are like internal wounds—they aren’t visible but can destroy lives. Leaders should assume that violations occur, even though they are often unintentional. However, to the person who feels harmed, it may not matter whether the harm was intentional or not. Marines rightly have an expectation that their leaders think ahead and plan for bizarre things that occur in urban combat. Marines do not expect their leader to be perfect or know all things, but they do expect their leader to act with honor and treat them with respect.

Some significant violations of the social contract are as follows:

• Carrying on as if you were expert on something you aren’t.

• Allowing anyone to abuse anyone else in your unit.

• Appearing to be putting your men at unnecessary risk so you can get a medal or say you had combat action.

• Displaying disrespectful, degrading or immoral behavior.

• Screaming when it isn’t necessary.

• Failing to provide information you could have provided.

• Appearing incompetent.

• Failing to “honor the dead”—including the enemy.

• Failing to respect the family at home.

It may be common to hear the phrase, “Suck it up,” but that attitude is not helpful and will not encourage your men to trust you. Even if you don’t share the same concerns your Marines have, listen to them when you can. Leaders help the Marines to rid themselves of some of their stress by leading by example. Marines form a social contract with those who lead them and they trust their leaders to uphold that trust through ethical decisions and ethical behavior in garrison and even more so in combat.

Unit discipline and the smart exercise of restraint in the application of force often go hand in hand. Unit leaders must teach their Marines what it means to exercise proper restraint in urban combat and these leaders must insist that their Marines practice it. Not only can a lack of restraint be counterproductive to mission accomplishment, it can also be unethical and can ultimately lead to discipline and morale problems that can cause operational stress reactions. The wise exercise of restraint in this sense is in keeping with our Core Values. Marines have an obligation to their unit and to the Marine Corps to uphold our high ethical standards—even when it is tough to do so; in fact, especially when it is tough to do. Small unit leaders play the most important, most influential role here. They must maintain an “ethical drumbeat,” constantly reinforcing desirable behavior even while promoting destruction of the enemy and safety for the innocent.

Moral Code Memory

Just as the leader trains his Marines to develop “muscle memory” for certain motor tasks required in combat, he also needs to see that his men develop a “moral code memory”⁶ regarding ethical behavior. You have to provide your men with clear guidance about acceptable and unacceptable behavior. But in the extremely complex fast-paced urban combat environment, Marines have to have “moral code memory” that is almost a natural reflex and guides them toward ethical choices. One of the ways to do this is by creating a command climate of ethical behavior. This command climate is critically important. Leaders should frequently emphasize ethical thinking and moral behavior by posting inspiring quotes or “Warrior Wisdom” in offices or on notebooks, screen savers, and email signatures;, sharing examples of military personnel who have demonstrated honor and courage under duress; and conducting training (in garrison and in theater) that includes difficult ethical scenarios.

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6 Dr. B.A. Dexter, CDR, USN

Small unit leaders will encounter challenges that are neither black nor white but somewhere in the gray area. For example, the platoon commander suspects that the government troops he is working with are being overly aggressive, even brutal in their treatment of the men that they suspect of aiding the enemy. The platoon commander rightly intervenes when he observes this trend, but he is unclear of how far he should go in dealing with the thorny issue. In another example, a squad leader observes one of his own Marines kick a detainee in the back of the head while that Marine is offloading him from the back of a 7-ton truck. The squad leader knows that his Marine is still extremely frustrated over an incident that happened a couple days before in which the squad was out in the town and was ambushed by insurgents and had a fellow squad member killed. The Marine suspects that the detainee either knew who ambushed them or actually took part in the ambush (based on intelligence and the circumstances of the detention). None of this justifies the abuse, and the squad leader knows his command must take appropriate disciplinary action. However, the squad leader also feels somewhat responsible because he knew that his men were filled with pent-up rage and he did not adequately address it before the abuse occurred. Combat in general and urban combat in particular places a heavy responsibility on junior leaders to do the right thing under the most difficult conditions.

Leaders must remember that in combat, men often revert to primitive survival behaviors. The desire to seek revenge has been shown to actually be hardwired into a part of the brain. However, though this tendency may be common, it is a distinct problem that must be controlled. Seeking revenge is an unacceptable combat behavior. Combat misconduct helps the enemy achieve his objectives—not ours. In present day urban conflict, the enemy relies on creating psychological stress to disable us. However, by conducting realistic training on difficult situations that may occur in urban combat, Marines learn that they should not let their “brains get hijacked by the emotions.” This will not take the edge off their ability to respond with decisive force to a threat. Marines with high levels of anger or with signs of operational stress are much more likely to engage in unethical behavior on the battlefield than Marines who do not harbor anger or have reactions to operational stress. Marines will be tested—especially in urban combat—and ethical behavior is like a muscle that must be exercised in order to stay strong.

Getting Help for Your Marines When Needed

The reality is that good Marines, even ones with all the right training and high morale, can experience combat stress injury. Leaders and their Marines need to be able to recognize psychological stress injury early and act to help their fellow Marine. A Marine who begins to experience psychological distress may not want anyone to know—thinking that it is not “manly” or Marine-like. However, Marines in combat, especially intense urban combat, are likely to witness horrific scenes. They may see one of their buddies literally ripped to pieces by an explosion or legs blown off by a rocket-propelled grenade. Marines will almost certainly have to aid seriously wounded comrades or pick up the remains of one of their fallen squad mates. Carrying body bags is tough—no matter how experienced a warrior you are. For others, the mere act of killing the enemy at the close ranges that are characteristic of urban combat will leave the Marine with haunting images that he cannot easily put out of his mind. These stark realities of urban combat—of life and death—can cause Marines to look for greater meaning in life and to question the purpose of the conflict more broadly.

It is important to remember that operational stress should in no way equate to unethical, immoral, or criminal behavior. Discipline and proactive leadership can prevent Marines from doing something for which they might later be sorry. Doing the right thing in the tough environment of urban conflict will be, for many, the supreme test of their character. Unfortunately, your Marines may not always feel better doing the right thing in a morally ambiguous situation. They must do so anyway. There is a big difference between an honest mistake and a willful breech of discipline. Breakdowns in discipline must never be tolerated, but honest mistakes should be treated for what they are. Pick the Marine up, dust him off, and make sure he learns from the experience. The ability of leaders to distinguish daily between these two categories is part of winning the trust of their Marines. Small unit leaders need to know that they have the authority of the Uniform Code of Military Justice behind them and that Marines punished appropriately.

If the small unit leader has prepared his Marines adequately, they should be able to recognize early warning signs of stress. Some of the stress responses men may experience are as follows:

• Difficulty falling asleep or staying asleep.

• Unusual fatigue.

• Difficulty concentrating.

• Unexplained physical illness.

• Apathy or carelessness.

• Unusual irritability, anger, or rage outbursts, sometimes with little provocation.

• Repeated disturbing dreams of a stressful experience.

• Uncontrollable pounding heart, sweating, or trouble catching your breath for no reason.

• Isolating yourself from other people, or having an unusually hard time being around others.

These stress responses (to be expected among at least some if not most men) are normal especially for Marines who have participated in sustained urban conflict. The presence of these symptoms does not mean that these Marines are “losing it.” These are natural human responses to the stresses of combat—particularly urban combat. Sometimes it is difficult to see the signs of combat stress in yourself, so Marines need to look out for each other. Leaders can help by encouraging Marines to talk through what they are feeling with their squad mates. Frank discussions among warriors are not evidence of weakness but rather a chance to work it out together. Once Marines realize that they are not alone in what they are experiencing and feeling, they are much more prone to deal positively with it and do so without guilt. Additionally, most urban combat areas now have access to combat stress professionals who may be able to provide proactive stress management training. Many of your Marines will feel more at ease, at least initially, talking confidentially with a chaplain. Leaders should strongly encourage their Marines to speak to the chaplain, even if the warning signs of operational stress are not particularly pronounced. Sometimes Marines just need to “talk it out” with someone who will simply listen.

Left unattended, operational stress can become a bigger problem. You don’t need specialized training, but you do need to know what to watch out for. The following behaviors reveal that a closer look is needed:

• Excess revenge fantasies or dehumanizing comments or behaviors.

• Sudden changes in behavior—acting out of character.

• Killing animals needlessly.

• Fighting.

• Disobeying orders.

• Careless behavior that endangers others.

• Any cruelty.

• Unusual weight loss.

• Lack of basic hygiene.

• Any of the suicide risk signs such as giving away property or comments about wanting to die.

• Failure to maintain uniform discipline or military courtesy.

• Panic attacks.

• Flashbacks that do not seem to be related to reality.

One motto some leaders use is, “You can always apologize later if you embarrass someone but you can’t bring anyone back from the dead.” If you or any of your Marines believe that another Marine may be headed for trouble you should pull them in and have them talk to your chaplain or medical officer. If nothing is seriously wrong the worst you did was perhaps embarrass them. But you did demonstrate good leadership by taking care of your men. Also, if your Marines begin to make dehumanizing comments, your responsibility as a leader is to stop the behavior. By not discouraging it, you are giving it your stamp of approval.

For Marines who do show the onset of psychological stress, the closer they stay to their unit, the better—and the more likely it will be that they will be successfully reintegrated once they are in a better frame of mind. For that reason, Marines should be moved from the company level to the battalion aid station. More serious cases may need to go to the regimental aid station. Unit leaders would do well to establish unit “rest and recuperation” areas for these cases. Often a Marine can recuperate after a few days of rest, recreation (such as movies and video games), a hot shower, and some good food. Give the Marine a chance to call home and speak to his loved ones. This brief “treatment” gives the Marine a chance to heal and recover. Easing him back to his unit is less difficult if he is not made to feel that he really ever left. He just took a break from the action to rest and “unwind.” One note of caution here: just because the Marine is able to return to duty does not mean that he did not experience a combat stress injury or that he is completely healed from the effects of the injury. Leaders need to keep a close eye on these Marines to ensure that they are indeed “good to go.”

Some situations are inherently high risk for psychological stress. Some examples of circumstances that may cause a small unit leader to ask for guidance from more senior leaders include—

• Multiple deaths in one unit in short period of time.

• Death or extreme suffering of non-combatants.

• Unusual exposure to dead bodies.

• Death of a “best friend”.

• “Friendly fire” incidents.

• Enemy atrocities.

• Significant misconduct behavior.

It may not be necessary to ask for help from outside of the unit if one of these events occurs, but it is wise to ask for guidance from your chain of command.

Combat Operational Stress Continuum Model

The Combat Operational Stress Continuum Model was developed by the Marine expeditionary forces, and Headquarters, Marine Corps. This model can be utilized by leaders as an aid to recognize and respond appropriately to the entire spectrum of possible symptoms of combat and operational stress. Appendix A depicts color-coded stress zones by degree of stress impairment and the extent to which help may be needed to promote recovery and healing. Marine leaders are responsible for recognizing when it is necessary to promote green zone readiness, to mitigate yellow zone reactions, to identify and care for orange zone stress injuries (most heal with proper recognition and care), and to treat and reintegrate red zone stress illnesses.

The Marine expeditionary forces and Headquarters, Marine Corps have also developed a Combat Operational Stress Decision Matrix flowchart as a tool for Marine leaders to assess which stress zone their Marines and Sailors are in at any given moment. Appendix B is a Decision Matrix flowchart that provides broad guidance for assessment of any distress or loss of function (signs of at least a yellow zone stress reaction), severe distress or loss of function (probably an orange zone stress injury), or persistent distress or loss of responding to these stress zones are included.

Summary

Small unit leaders have a great deal of responsibility for the welfare of their Marines. However they also are in the best position to create a culture of “combat response and resilience.” The popular press seems to focus almost exclusively on tragic stories of combat veterans who were harmed psychologically by their experiences. Yet every Marine leader knows countless combat veterans who built life-time bonds with other Marines in very dangerous circumstances. There are few or no other experiences in life that challenge one to such extremes. Clearly most Marines rise to those occasions and perform with honor and valor. When leaders inspire their Marines and provide strong interpersonal and moral leadership, they build resilience in their men. Positive combat responses include—

• Heightened alertness, strength, endurance, and tolerance to discomfort.

• Strong personal bonding between combat Marines.

• Pride and self identification with the unit’s history and Mission.

• Initiative and heroism.

These positive combat response behaviors can be brought forth by sound military training, wise personnel policies, and good leadership.

If a leader refers one of his Marines for professional help he is demonstrating the kind of wisdom the Marine Corps needs. As an illustration of the mind-body connection, think of what happens when someone breaks a bone. If the bone needs a cast, the cast helps the bone to grow correctly back together. The cast does not heal the bone—the body heals itself. And when the bone is healed it is stronger than it was before. It is less likely to break. When one of your Marines needs help with the psychological stress that urban combat can create, it is his own innate healing ability that will heal him. Chaplains and mental health professionals are like the cast that helps to guide the healing process. And just as you cut the cast away when you don’t need it anymore, people do in fact heal from psychological distress and become more resilient. Many Marines who have sought help after having disturbing combat experiences, report later that they feel more confident and more resilient even when returning to combat. As a leader you should expect recovery when one of your Marines needs help. The helping professionals available are part of your team and work to serve you and your Marines.

Leaders know that no one is perfect but they hold their Marines and themselves to high standards. By endeavoring to prevent and lessen psychological stress, the leader is a role model of wise leadership. You know that the mission can only be accomplished by Marines and that Marines are our single greatest resource.

Appendix A

Appendix B