A time scale in military stress response

摘要

371 soldiers, airmen and marines serving in a stressful fixed-tour tropical area who were referred for psychiatric opinion, were the subject of this prospective study of parameters of personality, diagnosis and prognosis. The conclusions based on the time-scale of individual tour length at referral were: 1) Early breakdown equated well with good resettlement following treatment in the same environment. 2) Late breakdown did nob, and was best handled by removal to base. 5) Early stage of tour breakdown correlated with young age group, (below 26 years), junior rank, (Corporal and below), and short service, (less than 6 years). 4) Late stage of tour breakdown correlated with older age group. (26 years +), more senior rank, (Sergeant and above), and longer service, (6 years -p). 5) Classification by diagnosis showed a preponed of reactive states at the beginning of the tour of duty abroad, and a preponderance of obsessional-somatic conditions later in the fixed expectation of duty tour, 6) The changeover from reactive to obsessional-somatic predominance occurred during this second octile of tour function, before and after which there were good olis on a case presenting as either the former or the latter respectively. 7) The reactive group oo;rrelati3d with sub-para l) and 3). 8) The obsessional-somatic group correlated with sub-paras 2.) and 4). 9) Despite the internally integrated nature of these two groups, separated by age, rank, length of service, diagnosis, time-scale of expression, response to treatment and prognosis for resettlement in the adverse environment, the numbers of each group in the diagnostic evaluation were almost identical, reactive group t obsessional- somatic - 10) It was concluded that each group was showing an equal response to a emotion adverse experience, which was modified by personality/maturity factors in a spectrum of individual time-scale experience. 11) The older serviceman, being a smaller absolute number in the military catchment, showed a relatively higher incidence of psychiatric disorder than his younger oolieague. 12) Using commencement of tour as a time-scale marker, cases could be reasonably well predicted ass a. Young age group - reactive - good prognosia. b. Older age group - obsessional with psychosomatic symptoms - limited prognosis. An extensive historical review of military literature over three decades, threw up I4 previously unrecorded casual interferences to a time-scale connection in military stress response. Following statistical evaluation, the author concluded that personnel who over react in the first octils of adverse experience are most likely if adequately treated and sensibly rehabilitated to be the hard dependable oops of the fourth quartile of experience. Those whose responsibilities, inhibitions or previous experience are partially protective, but who throw symptoms in the third and fourth quartiles, are the group of the greatest concern whose powers of intra-environment are most-limited and who are most likely to benefit from invaliding from the theatre of operation as a manpower saving measure. There is a motley group in the second ootile of time-scale whose destiny may be best handled in either compartment but who tend to layer prognostically with time. This thesis coordinates with the work of Glass, and of Anthony in examine unnecessary military personnel wastage through psychiatric channels. Pre-existing fixed and traditional attitudes are critically examined and some are refracted whon ixeen against a time-scale matrix. A common ground is found with the work of Rahe et al in San Diego in research into recent life style disturbance as a point of forward measurement in subsequent illness assessment. While this thesis on the one hand provides an understanding of and a basis for measurement of time-in-environment reactions following single major life change, Rahe's work provides on the other hand a predictive measure for continuous minor change or clumps thereof, a matter of isolated crucial stress versus multifactorial summated stress. It is considered that utilization of both concepts should provide a base brocai enough to cover the psychiatric evaluation of most human stress situations today.