Understanding stress in a combat environment

14 Aug 2007 | Sgt. Andy Hurt 13th Marine Expeditionary Unit

We live in the electronic age. The added comfort of phone and internet capabilities in forward areas can ease strain on personal relationships and business matters “back home.” During the brief contact service members have with their loved ones, generally only the most important words are exchanged: “How’s the baby? Really, her first tooth?” or “I’m safe, I love you.” Our phone calls “back home” are a great break from the reality of everyday life here. Rest assured, when a Marine hangs up the phone, he goes right back to scratching heat rash. He can smell his dirty body, feel his sore shoulders and hear IEDs in the distant night. While making a phone call can be the best part of the week, hanging up is the worst.

Stress is a big factor in a combat environment.

Navy Lts. Stephen Staub and Alan Bates are the Chief and Assistant Battalion Surgeons, respectively, for Battalion Landing Team 3rd Battalion, 1st Marines. Both agree that explaining stress factors and solutions to cope often brings factors to the table. Untreated stress, for example, can cause frequent headaches. A million things can cause headaches, so how is stress the automatic diagnosis?

Explaining the science behind stress, the doctors say, is the key to identifying and coping with it.

A Day in the Life

A day in a combat zone seems to last a lifetime. The environmental factors (relative to your location) alone can bring a man to his wit’s end. Dust, wind, heat, dust, bugs, dust … did we mention dust?

“Just being here is way more stressful than a day back in (the U.S.),” said Bates. “You’re away from your support system, your friends and your family … and you don’t have normal stress reducers like fast food, bars and clubs. Here, there’s no avenue of escape.” Everyday things like showers and cold water disappear once a unit goes “outside the wire” for patrolling and sweeps, which Bates’ says increases stress exponentially.

“Now we’re talking about life-threatening situations. You’re out there on a fourteen hour patrol, and every step you take could be on a pressure plate or something … you’re sleeping on dirt and drinking hundred-degree water.”

The Price We Pay

For the “Docs,” the cost cause results of stress are obvious and everywhere.

“Look around you,” said Staub, “everyone around here has lost ten to fifteen pounds … that’s the most obvious indicator of stress and you can see there is a negative balance here.”

Bates added: “I can see it in some of my corpsmen even. They came here as baby-faced nineteen-year-olds, and now that they’ve been in the sun everyday for sixteen hours on patrols, their skin is all leathery, they look older, some of ‘em got the ‘thousand yard stare’ or whatever. It’s stress.”

Sometimes stress is not so obvious, the two explained. When the initial symptoms of weight loss and visible fatigue have become commonplace, a keen eye and compassionate ear are needed to pinpoint excessive stress.

“When you’re under stress,” Staub began, “your body produces more stress-related hormones that cause high blood pressure, raised metabolism and increased blood sugar.

“The other thing we see is when stress gets to a level Marines can’t handle and it causes psychosomatic illnesses,” Staub said.

“They subconsciously turn their problems into something they can deal with like headaches, back pain, knee pain or stomach problems.”

“It’s usually some kind of pain,” Bates said.

Staub added, “But it’s based on psychological manifestations.”

“So,” continued Bates, “we can treat the pain, but if you remove the stressor, the pain will go away.”

The two explained that pain comes from two places: nerves and emotions. When a Marine is physically hurt, Tylenol and Motrin can treat the pain. When there are emotional factors involved, pain, or a manifestation thereof (i.e. stress), can be very difficult to treat.

“That’s why morale is so important,” said Staub. “If you’re in a good state of mind, the little things won’t seem as bad.” Quoting NFL quarterback Brett Favre, Staub added, “Pain is an issue of ‘mind over matter.’ If you don’t mind, it doesn’t matter.”

In basic training, Staub said, service members are taught to fight through stressful pain by executing on order countless push-ups, sit-ups and other rigorous physical activities. When the body is forced to perform, the mind learns it can perform. For combat-experienced Marines, the reaction to stress contrasts with that of Marines on their first deployment.

“The young guys may not have the consciousness for what’s going on,” Bates said. “They think ‘this hurts, but my platoon sergeant said keep going so I will.’ The sergeants, gunnery sergeants and first sergeants realize what’s going on inside themselves, and they know that stress does not equal shutting down.”

The Science of Stress

Stress and its symptoms boil down to a chemical release and reaction, synaptic relays and sensory input. There is an explanation for everything, but the truth is nothing short of pure magic, keeping Marines on the move.

“When you’re under stress,” began Staub, “your body produces more stress-related hormones like cortisol. They raise your blood pressure and metabolism, and basically get you ready for a meeting with a Saber-Tooth Tiger. It’s very primal.”

Staub continued: “On an evolutionary level, stress was created to get you running down the road, ‘fight or flight’ or ‘duck and cover,’ but it wasn’t meant to sustain you at this level for long periods of time.”

Said Bates: “The adrenaline rush you get is for a period of minutes, or an hour. Out here, we’re patrolling for four days.”

The prolonged high-intensity experiences on the battlefield take their toll on normal human stress reactions.

After a few days, said Staub, “You don’t respond as effectively to the short bursts. When someone is so stressed for so long, there may be a big blast – and you’re numb to it.”

“It could take something really catastrophic to get a normal stress response,” Bates added.

It is the long durations of chaotic experience, combined with geographic factors (the dust, wind and heat), combined with human factors like isolation, frustration and adrenaline bursts that begin to take a serious toll on health.

“In ‘normal life’ back home, your cycle is regulated,” said Bates. “The release of cortisol usually happens when you sleep and can help your body recover from stress. Here, the extended release of these hormones causes more negative effects, and Marines are more prone to infections, canker sores and depressed immunity.”

Sweet Relief

The spectrum of techniques for managing stress is enormous. Both doctors agree there is no “one size fits all” method, but there are eclectic methods Marines engage in every day – some of which they would normally condemn.

“We always talk about the benefits of exercise back home, but here there is nothing better than coming back from a patrol and sitting in your tent for awhile,” said Bates. “And as a physician I would never encourage someone to smoke or dip (chewing tobacco), but here it’s all we have, and it’s a social thing.”

“Some people need to be on their own,” Staub said, “but some people need a group. Some people need a book or movie to escape into and lose touch with reality, and some people need a physical challenge. The internet café is a great connection to ‘the real world’ and it acts like a light at the end of the tunnel.

“Guys that have been here two or three times know what their coping mechanisms are,” said Bates.

“The key is you have to have more than one,” Staub said, “If your only mechanism gets taken away, you won’t know what to do.”

When stress levels are balanced, however, Staub says the little bit of normal stress is effective in keeping Marines’ killer instinct in tact.

“We don’t want the whole camp Zen’d out like a Buddhist temple where everyone is fat and happy, but …”

“ … You don’t want the scales to tip, either,” Bates finished.

Scientifically speaking, the Doctors also agree that, while it may be undesirable, exercise is possibly the best way to cope with stress.

“If you look at long-endurance athletes who have sustained adrenaline, their body releases endorphins, like natural opiates,” said Bates. He explained that the “natural opiates” interact with pain receptors in the nervous system, causing the mythical “runners high.”

Bates continued: “So your body is releasing all these chemicals that tell you the pain is going away, which makes physical fitness effective stress relief, not only physically, but mentally.”

In a combat environment, all methods of stress relief share one common goal: War fighting effectiveness.

“If you’re physically fit, you’re going to be a better warrior,” Bates said. “When you’re out on a sixteen-hour patrol and you’ve already mimicked that stress (with exercise) you can get over that ‘wall.’”

“The wall,” said Staub, “is when someone starts exercising, they’re burning sugar in their muscles called glycogen. When it’s all used up, you feel exhausted like you can’t go anymore, and that’s when the body shifts gears and releases other types of energy – you get your second wind.”

“The Marine who’s physically fit is always better prepared to cope with stress,” Bates said. “Stress is a see-saw. When stress response worsens some aspects of health, exercise can make it better.”

Unanswered questions

Through exercise, reading or smoking, Marines in a combat environment have an effective means of stress management; but the question remains: Is stress turning us into perfect warriors through exercise and focus or is it slowly destroying us?

“In our country,” said Staub, “we work harder and take less vacation than most other countries. We’re the richest and most powerful country in the world, but we have more mental health issues and preventable issues like hypertension and diabetes. Is it worth it? It’s not for us to decide.”

The bottom line is this: Marines are warriors, first and foremost. For nearly 232 years, they have proudly excelled in situations similar to the perilous battlefield in Iraq. It is our hallmark to “adapt and overcome,” and by keeping watchful eyes on our brothers and sisters in arms, we will continue to fight our nation’s enemies in an effectively managed, stressful world.

For more information about the warriors of Battalion Landing Team 3rd Battalion, 1st Marines, or the 13th Marine Expeditionary Unit, visit the Unit Web site athttp://ww.usmc.mil/13thmeu.

13th Marine Expeditionary Unit