by Unknown
Exhaustion in Combat
Even as we consider the sunken-eyed, frog-eating, emaciated, and exhausted soldier of Ranger school, we must understand that the T H E W E I G H T O F E X H A U S T I O N
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combat exhaustion associated with months of continuous combat is something even worse, something that few soldiers have experienced outside of World War I, World War II, Korea, and some circumstances in Vietnam. Douglas MacArthur said of the soldier that "he plods and groans, sweats and toils, he growls and curses, and at the end he dies." T h e American soldier-cartoonist Bill Mauldin understood the mind-numbing fatigue of World War II combat and communicated it in his famous Willie and Joe cartoons.
"There are millions," wrote Mauldin, " w h o have done a great and hard j o b , but there are only a few hundred thousand w h o have lived through misery, suffering and death for endless 168-hour weeks."
Psychologist F. C. Bartlett emphasized the psychological impact of physical exhaustion in combat. "In war," he wrote, "there is perhaps no general condition which is more likely to produce a large crop of nervous and mental disorders than a state of prolonged and great fatigue." T h e four factors of (1) physiological arousal caused by the stress of existing in what is commonly understood as a continual fight-or-flight-arousal condition, (2) cumulative loss of sleep, (3) the reduction in caloric intake, and (4) the toll of the elements — such as rain, cold, heat, and dark of night — assaulting the soldier all combine to form the "state of prolonged and great fatigue" that is the Weight of Exhaustion. Let us briefly review these factors.
Physiological Exhaustion
And then a shell lands behind us, and another over to the side, and by this time we're scurrying and the sarge and I and another guy wind up behind a wall. The sergeant said it was an .88 and then he said, "S and s some more."
I asked him if he was hit and he sort of smiled and said no, he had just pissed his pants. He always pissed them, he said, just when things started and then he was okay. He wasn't making any apologies either, and then I realized something wasn't quite right with me, either. There was something warm down there and it seemed to be running down my leg. I felt, and it wasn't blood. It was piss.
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I told the sarge, I said, "Sarge, I've pissed too," or something like that and he grinned and said, "Welcome to the war."
— World War II veteran
quoted in Barry Broadfoot, Six Year War, 1939-1945
To understand the intensity of the body's physiological response to the stress of combat we must understand the mobilization of resources caused by the body's sympathetic nervous system, and then we must understand the impact of the body's parasympathetic backlash response.
The sympathetic nervous system mobilizes and directs the body's energy resources for action. T h e parasympathetic system is responsible for the body's digestive and recuperative processes.
Usually these two systems sustain a general balance between their demands upon the body's resources, but during extremely stressful circumstances the fight-or-flight response kicks in and the sympathetic nervous system mobilizes all available energy for survival. In combat this very often results in nonessential activities such as digestion, bladder control, and sphincter control being completely shut down. This process is so intense that soldiers very often suffer stress diarrhea, and it is not at all uncommon for them to urinate and defecate in their pants as the body literally "blows its ballast" in an attempt to provide all the energy resources required to ensure its survival.
A soldier must pay a physiological price for an energizing process this intense. The price that the body pays is an equally powerful backlash when the neglected demands of the parasympathetic system return. This parasympathetic backlash occurs as soon as the danger and the excitement is over, and it takes the form of an incredibly powerful weariness and sleepiness on the part of the soldier.
Napoleon stated that the moment of greatest danger was the instant immediately after victory, and in saying so he demonstrated a remarkable understanding of h o w soldiers become physiologically and psychologically incapacitated by the parasympathetic backlash that occurs as soon as the m o m e n t u m of the attack has halted and the soldier briefly believes himself to be safe. During this period of vulnerability a counterattack by fresh troops can have an effect T H E W E I G H T O F E X H A U S T I O N
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completely out of proportion to the number of troops attacking.
It is basically for this reason that the maintenance of fresh reserves has always been essential in combat, with battles often revolving around which side can hold out and deploy their reserves last.
Clausewitz cautioned that these reserves should always be maintained out of sight of the battle. These same basic psychophysiologi-cal principles explain why successful military leaders have historically maintained the momentum of a successful attack. Pursuing and maintaining contact with a defeated enemy are vital in order to completely destroy the enemy (the vast majority of the killing in historical battles occurred during the pursuit when the enemy had turned his back), but it is also valuable to maintain contact with the enemy as long as possible in order to delay that inevitable pause in the battle that will result in the culmination point during which pursuing forces will slip into parasympathetic backlash and become vulnerable to a counterattack. Again, an unblown reserve ready to complete this pursuit is of great value in ensuring that this most destructive phase of the battle is effectively executed.
In continuous combat the soldier roller-coasters through seemingly endless surges of adrenaline and subsequent backlashes, and the body's natural, useful, and appropriate response to danger ultimately becomes extremely counterproductive. Unable to flee, and unable to overcome the danger through a brief burst of fighting, posturing, or submission, the bodies of modern soldiers quickly exhaust their capacity to energize and they slide into a state of profound physical and emotional exhaustion of such a magnitude and dimension that it appears to be almost impossible to communicate it to those who have not experienced it. A soldier in this state will inevitably collapse from nervous exhaustion — the body simply will burn out.
Lack of Sleep
I have already mentioned the hallucinations and zombielike states commonly experienced due to lack of sleep in intensive training, such as in the U.S. Army Ranger school. In combat it is often far worse. Holmes's research indicates that tremendous periods of sleep loss are the norm in combat. In one study it was determined that of American soldiers in Italy in 1944, 31 percent averaged 72
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fewer than four hours' sleep a night, and another 54 percent averaged fewer than six. Those individuals with the lower amounts of sleep were most likely to have come from the frontline units, which is also where the highest incidence of psychological casualties occurred.
Lack of Food
Lack of nourishment resulting from bad, cold food, and a loss of appetite caused by fatigue, can have a singularly devastating impact on combat effectiveness. "I would say without hesitation," wrote the British general Bernard Fergusson, "that lack of food constitutes the single biggest assault upon morale. . . . Apart from its purely chemical effects upon the body, it has woeful effects upon the mind."
In numerous historical incidents lack of food was believed to have been the single most important military factor. The Army Historical Series volume on logistics affirms that "lack of food probably more than any other factor forced the end of resistance on Bataan" early in World War II, and the Germans at Stalingrad were "literally starving at the time of their capitulation."
Impact of the Elements
Soldiering, by its very nature, involves facing the forces of nature as well as the forces of the foe. Limited to those few amenities that they can carry on their backs after room has been made for the equipment of their profession, most soldiers are more or less at the mercy of the elements. Thus endless cold, rain, heat, and
suffering become the soldier's lot.
Lord Moran believed that "armies wilt when exposed to the elements." For him the worst was "the harsh violence of winter,"
which can "find a flaw even in picked men." And the constant torment of the rain led Henri Barbusse to write that "dampness rusts men like rifles, more slowly but more deeply."
Another potential enemy of the soldier is the sensory deprivation of darkness, which can conspire with the cold and the rain to produce a degree of misery such as the protected shall never know. For Simon Murry, a French veteran of Algeria, coldness was "enemy number one." For him, "the misery of crawling into T H E W E I G H T O F E X H A U S T I O N
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a sleeping-bag which is wet and sodden in total blackness on top of a mountain with the rain pissing down" was misery "without parallel."
Heat, too, can exhaust and kill; and rats, lice, mosquitoes, and other living elements of nature take their turns at exacting both a physical and a psychological toll upon the soldier, but the most deadly of all these natural enemies that the soldier must face is probably disease. In every American war up until World War II more soldiers died from disease than from enemy action.
And so we see that lack of sleep, lack of food, the impact of the elements, and emotional exhaustion caused by constant fight-or-flight-response activation all conspire to contribute to the soldier's exhaustion. This is a burden that, if not capable of causing psychiatric casualties in and of itself, needs to be taken into consideration as being capable of predisposing the soldier's psyche toward seeking escape from the deprivations that surround him.
Chapter Four
The Mud of Guilt and Horror
I am sick and tired of war. It's glory is all moonshine. It is only those who have neither fired a shot nor heard the shrieks and groans of the wounded who cry aloud for blood, for vengeance, for desolation. War is hell.
— William Tecumseh Sherman
The Impact of the Senses
Beyond fear and exhaustion is a sea of horror that surrounds the soldier and assails his every sense.
Hear the pitiful screams of the wounded and dying. Smell the butcher-house smells of feces, blood, burned flesh, and rotting decay, which combine into the awful stench of death. Feel the shudder of the ground as the very earth groans at the abuse of artillery and explosives, and feel the last shiver of life and the flow of warm blood as friends die in your arms. Taste the salt of blood and tears as you hold a dear friend in mutual grieving, and you do not k n o w or care if it is the salt of your tears or his. And see what hath been wrought:
You tripped over strings of viscera fifteen feet long, over bodies which had been cut in half at the waist. Legs and arms, and heads THE M U D OF GUILT AND H O R R O R 75
bearing only necks, lay fifty feet from the closest torsos. As night fell the beachhead reeked with the stench of burning flesh.
— William Manchester,
Goodbye, Darkness
The Impact of Memory and the Role of Guilt Strangely, such horrifying memories seem to have a much more profound effect on the combatant — the participant in battle —
than the noncombatant, the correspondent, civilian, POW, or other passive observer of the battle zone. The combat soldier appears to feel a deep sense of responsibility and accountability for what he sees around him. It is as though every enemy dead is a human being he has killed, and every friendly dead is a comrade for whom he was responsible. With every effort to reconcile these two responsibilities, more guilt is added to the horror that surrounds the soldier.
Richard Holmes speaks of "a brave and distinguished" old veteran who, after nearly seventy years, "wept softly . . . as he described a popular officer who had been literally disemboweled by a shell fragment." Often you can keep these things out of your mind when you are young and active, but they come back to haunt your nights in your old age. "We thought we had managed all right," he told Holmes, "kept the awful things out of our minds, but now I'm an old man and they come out from where I hid them. Every night."
And yet, all of this, this horror, is just one of the many factors among those that conspire to drive the soldier from the painful field.
Chapter Five
The Wind of Hate
Hate and Trauma in Our Daily Lives
When we consider the matter, are we truly surprised to discover that it is not danger that causes psychiatric stress? And is the existence of an intense resistance to participating in aggressive situations really so unexpected?
To a large extent our society — particularly our young men —
actively and vicariously pursues physical danger. Through roller coasters, action and horror movies, drugs, rock climbing, white-water rafting, scuba diving, parachuting, hunting, contact sports, and a hundred other methods, our society enjoys danger. To be sure, danger in excess grows old fast, particularly when we feel that we have lost control of it. And the potential for death and injury is an important ingredient in the complex mixture that makes combat so stressful, but it is not the major cause of stress in either our daily lives or in combat.
But facing aggression and hatred in our fellow citizens is an experience of an entirely different magnitude. All of us have had to face hostile aggression. On the playground as children, in the impoliteness of strangers, in the malicious gossip and comments of acquaintances, and in the animosity of peers and superiors in the workplace. In all of these instances everyone has known hostil-T H E W I N D O F H A T E
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ity and the stress it can cause. Most avoid confrontations at all costs, and to work ourselves up to an aggressive verbal action — let alone a physical confrontation — is extremely difficult.
Simply confronting the boss about a promotion or a raise is one of the most stressful and upsetting things most people can ever bring themselves to do, and many never even get that far. Facing down the school bully or confronting a hostile acquaintance is something that most will avoid at all costs. Many medical authorities believe that it is the constant hostility and lack of acceptance that they must face — and the resulting stress — that are responsible for the dramatic rate of high blood pressure in African Americans.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R), the bible of psychology, states that in post-traumatic stress disorders "the disorder is apparently more severe and longer lasting when the stressor is of human design." We want desperately to be liked, loved, and in control of our lives; and intentional, overt, human hostility and aggression — more than anything else in life —
assaults our self-image, our sense of control, our sense of the world as a meaningful and comprehensible place, and, ultimately, our mental and physical health.
The ultimate fear and horror in most modern lives is to be raped or beaten, to be physically degraded in front of our loved ones, to have our family harmed and the sanctity of our homes invaded by aggressive and hateful intruders. Death and debilitation by disease or accident are statistically far more likely to occur than death and debilitation by malicious action, but the statistics do not calm our basically irrational fears. It is not fear of death and injury from disease or accident but rather acts of personal depredation and domination by our fellow human beings that strike terror and loathing in our hearts.
In rape the psychological harm usually far exceeds the physical injury. The trauma of rape, like that of combat, involves minimal fear of death or injury; far more damaging is the impotence, shock, and horror in being so hated and despised as to be debased and abused by a fellow human being.
The average citizen resists engaging in aggressive and assertive activities and dreads facing the irrational aggression and hatred of 78
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others. The soldier in combat is no different: he resists the powerful obligation and coercion to engage in aggressive and assertive actions on the battlefield, and he dreads facing the irrational aggression and hostility embodied in the enemy.
Indeed, history
is full of tales of soldiers who have committed suicide or inflicted terrible wounds upon themselves to avoid combat. It isn't fear of death that motivates these men to kill themselves.
Like many of their civilian counterparts who commit suicide, these men would rather die or mutilate themselves than face the aggression and hostility of a very hostile world.
The Impact of Hate in Nazi Death Camps
An abnormal reaction to an abnormal situation is normal behavior.
— Victor Frankl, Nazi concentration-camp survivor Perhaps a deeper understanding of the power of the buffeting of hate can be obtained from a study of survivors of Nazi concentration camps. Even the briefest review of available literature reveals that these individuals did suffer from great, lifelong, psychological damage as a result of their experiences in concentration camps, even though they did not have any obligation or ability to kill their tormentors.4 Among bombing victims, POWs under artillery fire, sailors in naval combat, and soldiers on patrols behind enemy lines we do not find any large-scale incidence of psychiatric casualties, but in such places as Dachau and Auschwitz they were the rule rather than the exception.
This is one historical circumstance in which noncombatants did suffer a horrifyingly high incidence of psychiatric casualties and post-traumatic stress. Physical exhaustion is not the only or even the primary factor involved here. And neither is the horror of the death and destruction around them principally responsible for the psychic shock of this situation. The distinguishing characteristic here, as opposed to numerous other noncombatant circumstances marked by an absence of psychiatric casualties, is that those in concentration camps had to face aggression and death on a highly personal, face-to-face basis. Nazi Germany placed a remarkable concentration of aggressive psychopaths in charge of these camps, T H E W I N D O F H A T E