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Worry in Warriors
Lt Col Md Rabiul Alam AMC
MBBS, MCPS, FCPS (Anaesthesiology)
Classified Specialist in Anaesthesiology
 
INTRODUCTION
Worry denotes a strong feeling of anxiety. In the 16th century the word
worry 
 began to be used in the sense
 „
to harass, a
s by rough treatment or attack,‟ 
or
 „to
ass
ault verbally,‟ 
and in the 17th century the word took on the sense
 „
to bother,distress, or persecute.
‟ 
It was a small step from this sense to the main modern
senses „
to cause to feel anxious
or distressed‟ 
and
 „to feel troubled or uneasy,‟ 
firstrecorded in the 19th century.Warriors are the persons who are engaged in or experienced in warfare. Due to thevery pattern of their jobs, daily lives, serious responsibilities and assignments
–
 most of the time
–
it is unavoidable to remain in worry by the warriors. The modernworld, which is said to be a world of achievement, is also a world of stress. Onefinds stress everywhere, whether it be a family, a military station, a governmentset-up or any other social or economic organization. Worry or stress is an inevitableconsequence of socio-
economic complexity and, to some extent it‟s stimulant as
well. People experience stress as they can no longer have complete control overwhat happens to their lives.The present-day researcher visualizes the phenomenon of stress in a newperception. Each individual needs a moderate amount of stress to be alert andcapable of functioning effectively in an organization. Stress is inherent in theconcept of creativity and entrepreneurship. Stress is like electricity. It can make abulb glow and provide brilliant illumination. However, if voltage is higher than thebulb can take and the coping mechanism for higher voltage is ineffective, it resultsin loss of effectiveness or burnout. A burnout can be defined as the end result of stress experienced, not properly coped with, resulting in exhaustion, irritation,ineffectiveness, problems of health etc. The opposite phenomenon of glow upoccurs when stress is properly channelized resulting in a feeling of challenge, jobsatisfaction, creativity, effectiveness and better adjustment to work and life.When individuals express stress, they try to adopt ways of dealing or coping with itas they cannot remain in a constant state of tension. They think over the stressfulevent and devise ways and means to adjust to such stressful events.Transformational coping involves altering the events so that they are less stressful.One has to interact with the events so that they are steered towards a less stressfuldirection. Regressive coping, on the other hand, includes a strategy wherein one
 
thinks about the events pessimistically and acts evasively to avoid contact withthem.
INCIDENCE IN ARMED FORCES PERSONNELIn British Armed Forces
British commanders have raised concerns about the ability of the armed forces tocope with simultaneous major operations in Iraq and Afghanistan, and the UKarmed forces have been asked to do more than was envisaged in the most recentdefense review.Personnel who were deployed for 13 months or more in the past three years weremore likely to fulfil the criteria for post-traumatic stress disorder and had multiplephysical symptoms. A significant association was found between duration of deployment and severe alcohol problems. Exposure to combat partly accounted forthese associations. The associations between number of deployments in the pastthree years and mental disorders were less consistent than those related toduration of deployment. Post-traumatic stress disorder was also associated with amismatch between expectations about the duration of deployment and the reality.The researchers concluded that a clear and explicit policy on the duration of eachdeployment of armed forces personnel may reduce the risk of post-traumatic stressdisorder. An association was found between deployment for more than a year in thepast three years and mental health that might be explained by exposure to combat.
In US Army
Epidemiological studies have shown that mental disorders are associated withreduced health-related quality of life, high levels of health care utilization, and workabsenteeism. However, measurement of the burden of mental disorders by usingpopulation-based methods in large working populations, such as the U.S. military,has been limited. Analysis of hospitalizations among all active-duty militarypersonnel (16.4 million person-years) from 1990 to 1999 and ambulatory visitsfrom 1996 to 1999 was conducted by using the Defense Medical SurveillanceSystem. Rates of hospitalization, ambulatory visits, and attrition from militaryservice were compared for persons with mental disorder diagnoses and those withdiagnoses in 15 other ICD-9 disease categories.Mental disorders was the leading category of discharge diagnoses among men andthe second leading category among women; 13% of all hospitalizations and 23% of all inpatient bed days were attributed to mental disorders. Six percent of themilitary population received ambulatory services for mental disorders annually in1998 and 1999. Among a 1-year cohort of personnel, 47% of those hospitalized forthe first time for a mental disorder left military service within 6 months. This
 
attrition rate was significantly different from the rate of only 12% afterhospitalization for any of the 15 other disease categories. The difference remainedsignificant after controlling for effects of age, gender, and duration of service. Theyconcluded that mental disorders appear to represent the most important source of medical and occupational morbidity among active-duty U.S. military personnel.These findings provide new population-based evidence that mental disorders arecommon, disabling, and costly to society.
PROPOSED CAUSES OF WORRY
The delay or denial of expected promotion and posting, job pressure, behaviour of section commanders/peers, sickness, marital disharmony, poor performance of children at school etc could be the causes of stress. Even trifles such as telephonegoing out of order, power shut down and irregular water supply can give rise tostress. But then stress is necessary for human progress. It is like the strings of amusical instrument where an optimum amount of stress is necessary to producegood music. Loose wires (less stress) would not produce the notes and too much of tension (excessive stress) would lead to screening.
The potential sources of stress are following:
Environmental Factors: Environ-mental factors i.e. posting to a place under fieldconditions, tough climatic conditions etc can be stress-inducing. Technologicaluncertainty like induction of new armaments, equipments, machineries, techniquesand inventions in military science can also cause stress because new machinery,
equipment and inventions can make employees‟ skill and experience obsolete in a
very short period of time. Computers, office automation and similar technologicalinnovations could be a source of stress to many.Organisational Factors: Pressure to avoid error, completion of task in limited time,work overload, demanding and insensitive contingent commanders and unplannedworkers are a few examples of organisational factors. Poor inter-personnelrelationship and lack of support from colleagues can cause considerable stressespecially among persons with high social need.Individual Factors: In the Armed Forces, an individual generally works for about 44-48 hours a week. The problems that people encounter in other 108 non-workinghours each week can spill over to the job. Individual factors generally encompass
factors in the employee‟s personal life. These could be marital difficulties, family
issues, economic problems, inherent personality characteristics, medical problemsof relatives etc that create stress for employees when they arrive at work.Agony has an addictive phenomenon. It builds up. Each new and persistent stressoradds to an individual's stress level. A single stressor may seem relatively
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