Wednesday, June 29, 2011

Family Medicine: Learning from Stress in the Military- Can We Forget the Tiger?

"Stress" is a concept that we all can relate to, but each has their own set of stress definitions.  How does the US Army understand Stress?  Here is an excerpt from the section on "Stress and Combat Performance" from the US Army Combat Stress Control Handbook (Lyons Press 2005, pp 33-35).  Does any of this sound like your life?:

"Stress is an internal process which presumably evolves because it helps the individual to function better, stay alive, and cope successfully with stressors.  However, there is an optimal range of arousal (or motivation or stress) for any given task.

     a.  If there is too little arousal, the job is done haphazardly or not at all because the individual is easily distracted, makes errors of omission, or falls asleep.  If arousal becomes too intense, the individual may be too distractible or too focused on one aspect of the task. He may have difficulty with fine motor coordination and with discriminating when and how to act.  If the individual is unfamilial with his own stress reflexes and perceives them as dangerous (or incapacitating, or as a threat to self-esteem), the stress itself can become a stressor and magnify itself.

     b.  With extreme arousal, the individual may freeze.  Alternately, he may become agitated and flee in disoriented panic.  If stress persists too long, it can cause physical and mental illness.  Extreme stress with hopelessness can even result in rapid death, either due to sympathetic nervous system over-stimulation (such as stroke or heart attack) or due to sympathetic nervous system shutdown (not simply exhaustion).  An individual giving up can literally stop the heart from beating.

     c.  The original purpose of the stress reaction was to keep the person alive.  The military requirement for the stress process is different.  It is to keep the soldier in that range of physiological, emotional, and cognitive mobilization which best enables him  to accomplish the military mission, whether that contributes to individual survival or not.  This optimal range of stress differs from task to task.  Tasks which require heavy but gross muscular exertion are performed best at high levels of arousal.  Tasks that require fine muscle coordination and clear thinking (such as walking point on a booby-trapped jungle trail or distinguishing subtle differences between friendly and enemy targets in a night-vision gun sight) or that require inhibiting acrion (such as waiting alertly in ambush) will be disrupted unless the stress process is kept finely tuned.  If the stress process allows too much or too little arousal or if arousal does not lessen when it is no longer needed, stress has become harmful."

I underlined the one phrase about "whether that contributes to individual survival or not".  In the military, sometimes mission accomplishment results in loss of life.  In the REHEARSAL for D Day in 1944, there were about 800 deaths.  This is way beyond what is supposed to happen in our work places, but many times our bodies are reacting as if a tiger is about to attack us.  Our body then gets an intense stress reaction.  Once we know we can respond successfully to tiger attacks with learning and maturity, we don't need as many tigers.  Can't we get away from the tigers?  Can't we find ways to reduce the pressure on each other and become more human-centered?  Isn't it time?

In Family Medicine, we have opportunities to help people to identify their stressors and upgrade their coping skills.  We know how to help people to clear up their view of their personal tigers and balance their stress without having a heart attack.  Stress can be helpful, as noted by the US Army, but also dangerous.  We don't have to be soldiers and experience combat to develop a variety of responses to stress.  Human to human, not tiger to tiger, we can move ahead with more balanced stress responses.

What do you think?


  1. I love the idea, I think reality is against us. I think emotional immaturity is pretty common.

    What kind of coping advice do you give?

    All I can come up with is copious quantities of dark chocolate.

    Oh, and reframing.


  2. For coping, I advise many to use the heart-based strategies emphasized on Calendaring the stress/ grief,etc is another frequent suggestion. I expound on these in my series about the Human Centered Health Home.
    Everyone is unique, so the relationship based nature of Family Medicine is helpful to have a better understanding of how to proceed with each patient.