Migrations, Colonizations, and Diasporas in Archaeology
See also: Demographic Techniques: Data Adjustment
and Correction
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M. Otte
Military and Disaster Psychiatry
1. Introduction
Whether by force of humans or nature, massive
destruction creates an atmosphere of chaos and
compels individuals to face the terror of unexpected
injury, loss and death. In times of disaster or war,
psychological injury may occur as a consequence
of exposure to physical injury, disruption of the
environment, or the terror or helplessness produced
by these events. To address such injury in a timely
manner, mental health care must be provided in
environments near chaos and destruction, as well as in
9850
the hospital. The disciplines of military and disaster
psychiatry address care demands in nontraditional
environments and in mass casualty situations, where
resources are overwhelmed. Care in these environ-
ments relies on contributions not only from psy-
chiatrists, but also from other physicians, social
scientists, epidemiologists, psychologists, nurses and
emergency responders such as police and firemen.
This overview of military and disaster psychiatry
begins with an examination of the consequences of
disasters and wars for communities, and the evolution
of medical responses to these traumatic experiences. A
discussion of the phenomenology of trauma-related
psychiatric morbidity and principles of prevention,
mitigation of consequences, and management follows.
Finally, transnational economic, ethical and legal
trends are presented as issues requiring further study.
2. Practice En
ironments in Military Operations
and Disasters
‘Disaster’ has numerous definitions. The word is
derived from the Latin dis (‘against’) and astrum
(‘stars’)—‘the stars are evil’. A disaster such as an
earthquake or a flood overwhelms a community’s
capacity to respond. The distinction between ‘natural’
disasters (e.g., earthquakes) and human-made or
technological ones such as explosions, or train
derailments is increasingly difficult to make. For
example, much of the death and destruction from an
earthquake may be due to poorly constructed
housing—thus, there is a human-made element to the
consequences of even ‘natural’ disaster. From a
psychological standpoint, a more critical distinction
concerns whether the disaster was inflicted inten-
tionally, as is the case with acts of war or terrorism.
War may be defined as a political act (generally
involving violence) to achieve national objectives or
protect national interests. During the last 30 years,
militaries around the world have increasingly become
involved in peacekeeping and humanitarian relief
missions. The use of military forces in these endeavors
also maintains a country’s influence and minimizes
political instability in the affected nation.
The potential stressors in all disaster environments
include exposure to the dead and grotesque, threat to
life, loss of loved ones, loss of property, and physical
injury. Although the military brings supplies and
a portable living environment to protect soldiers,
civilians (frequently exposed to combat environments
in modern times) may be subject to large-scale devasta-
tion, become refugees, and experience shortages that
threaten life. Frequently, such victims do not receive
treatment for psychiatric symptoms that emerge from
bombings, battle, rape, torture and unrestrained
murder. Although an earthquake may be concluded
in seconds, the consequent traumatic experience may

continue for weeks, months and possibly years. For
both soldiers and civilians in combat environments,
exposure over time may include anticipated or entirely
unexpected life-threatening experiences followed by
daily life in an austere and disrupted environment.
The emotional and behavioral responses following
a disaster occur in four phases. The first immediately
following a disaster generally consists of strong
emotions including feelings of disbelief, numbness,
fear and confusion—normal emotional responses to
an abnormal event. The second phase usually lasts
from a week to several months and is accompanied by
the appearance of assistance from outside agencies
and communities. Adaptation to the austere environ-
ment as well as intrusive symptoms (unbidden
thoughts and feelings accompanied by hyper-arousal)
occur during this phase. Somatic symptoms such as
fatigue, dizziness, headaches and nausea may develop.
Anger, irritability, apathy, and social withdrawal are
often present. The third phase is marked by feelings of
disappointment and resentment when hopes for aid
and restoration are not met. Here, often, the sense of
community is weakened as individuals focus on their
personal needs. The final phase, reconstruction, may
last for years. During this period, survivors rebuild
their lives, make homes and find work using available
social supports. Individuals may progress through
these phases at various rates. Many persons may be
unable to reconstruct their lives fully and instead
develop persistent symptoms.
The causes of disaster and war have been historically
attributed to sources ranging from the gods, to the
wind of a passing cannonball, and various natural,
unnatural or supernatural sources of contagion.
Emotional consequences of disaster are described in
the Iliad, and references to the terror induced by the
attack of this hero are diverse. Ancient Greeks
attributed epidemic illness to Apollo’s wrath after the
desecration of his temple. The French military surgeon
Larrey commented clearly on the ill effects of war
upon the health of Napoleon’s soldiers. Others
commented on combat-related pathological behaviors
during the US Civil War, and recent studies have
noted the descriptions of veterans of that war
hospitalized for symptoms very similar to those of
today’s Post Traumatic Stress Disorder (PTSD).
The science of neurology entered military medicine
with Weir Mitchell’s work during and after the Civil
War. Over the remainder of the nineteenth and
twentieth centuries studies increasingly distinguished
between diseases of the nervous system for which
traumatic lesions could be demonstrated and those
for which no such lesion could be identified. The
concepts of neurasthenia, dissociation, hysteria and
psychological suggestion were developed to define
psycho–neurological states without demonstrable
anatomic abnormality.
Military physicians in the Russo–Japanese War
made similar diagnostic distinctions. Recognition of
Military and Disaster Psychiatry
the ‘nontraumatic’ injuries that followed railway
accidents and other technological disasters occurred
at the same time. Military psychiatric experience in
World Wars I and II led to the development of specific
treatment principles. During World War I, physicians
from various armies addressed the problem of soldiers
with emotional or behavioral disturbances with a
variety of diagnostic labels such as shell shock,
gas neurosis and conversion paralysis. Treatment
ranged from prolonged psychiatric hospitalization, to
punishing electric shock and various talk therapies.
Gradually, US, Canadian and British forces incor-
porated into their treatments the expectation that
these soldiers return to battle after brief evaluations.
German military scientists recognized the importance
of unit cohesion in mitigating psychological injury.
Elsewhere, efforts were made to screen out soldiers felt
to be at risk for psychological disturbances on the
assumption that these soldiers were genetically weak.
Although the terms proximity (treatment near the
combat zone), immediacy (early identification of
stress-related disorders), simplicity (treatment with
rest, food and brief support) and expectancy (ex-
pectation of prompt recovery and return to duty)
were defined in later conflicts, these practices evolved
to varying degrees during World War II. These
principles, along with the development of psycho-
tropic medications, the failures of screening programs,
and the recognition of the problems of drug abuse
in operational environments greatly influenced the
management practices of subsequent military and
disaster responders.
Civilian physicians have also long recognized the
trauma of war as a cause of human suffering. In 1859,
Jean Henri Dunant arranged for civilian medical
services for the injured after observing soldiers die
from lack of medical attention during the Battle of
Solferino. His efforts led to the establishment of the
International Red Cross, and to international guide-
lines for humane care to the sick and wounded in
times of war. During the later part of the twentieth
century the Red Cross, and other international
medical and relief agencies such as Doctors Without
Borders increasingly provided mental health-related
consultation, education and direct care in the after-
math of war, natural and human-made disasters. The
World Health Organization and the Pacific–Asian
Health Organization have also supported inter-
national disaster relief efforts.
3. Phenomenology
3.1 Symptoms
ersus Functioning
Military and disaster psychiatry must address the
clinical concerns of identified patients, but must also
strive to prevent potentially incapacitating morbidity
9851
Military and Disaster Psychiatry
in entire populations. Distress-related symptoms
are universal during disasters and combat. Initial
psychiatric response in the aftermath of war and
disaster must focus on mobilizing effective function-
ing. Symptoms occurring in persons who are not
impaired are a secondary concern. Such symptoms can
become ‘medicalized’ if clinicians cause impaired
functioning by unjustifiably reinforcing a view that
symptoms are due to a disease. While the ultimate
label given to clusters of symptoms has political,
economic and research-related significance, the self-
perception that one is ill can become a powerful
determinant of impaired functioning both during and
after combat and disasters.
3.2 Military Operations, Disasters and Psychiatric
Syndromes
Much of military and disaster psychiatry focuses on
the myriad behavioral reactions to stressful events—
‘stressors’. Well-defined psychiatric syndromes de-
scribe many of these responses. The precipitating
stressor for PTSD involves a threat to the physical
integrity of self or others, so immediate that the
exposed individual suffers a potent sense of helpless-
ness, horror or fear. A characteristic distress response
may follow such trauma. This response consists of
symptoms that involve: (a) ‘reliving’ the original event
(e.g., nightmares, distressing vivid recollections or
fear when exposed to events resembling the original
trauma); (b) numbing of responsiveness or behavioral
avoidance of events or situations that somehow
resemble or symbolize the original trauma; and (c)
symptoms of increased vigilance, such as exaggerated
startle, outbursts of anger or other evidence of
hyper-arousal. If these symptoms of severe distress
persist for over a month, then a diagnosis of PTSD
is appropriate. Symptoms may first occur months
or even years after the triggering event, but this
is not the norm. If symptoms occur within the first
month after the trauma and have not lasted longer
than a month, then Acute Stress Disorder (ASD) is
diagnosed. Controversy persists regarding the diag-
nostic validity PTSD, probably because it was defined
in the aftermath of the Vietnam War in the wake of
political and antiwar pressures. Nonetheless, PTSD
and ASD are conceptualized as modal distress
responses to severe or catastrophic stressors, and have
been as carefully defined and delineated as other
psychiatric disorders.
Disabling distress reactions occur in response to less
significant trauma and present in patterns not de-
scribed by PTSD or ASD. Adjustment Disorder, for
example, is a maladaptive behavioral and\or emotion-
al response to a diverse array of stressors. Conversion
Disorder may be diagnosed when one develops un-
explained symptoms or deficits affecting voluntary
motor or sensory function (e.g., sudden paralysis of
the ‘trigger’ finger) without demonstrable neuro–
9852
anatomical injury. Bereavement, a normal grief re-
action after the death of someone who is valued or
loved, may also occur in response to losses incurred
during war or disaster. Other distress responses to war
or disaster include anxiety and depressive syndromes,
and antisocial behavior (involving acts of violence,
criminal behavior, military misconduct, or war-related
atrocities). Alterations in health-related behaviors
(e.g., misuse of tobacco, drugs or alcohol, poor eating
habits) may also develop after exposure to disaster or
war.
3.3 Battle Fatigue
The term ‘battle fatigue’ provides a framework to
encompass the variety of responses to operational
stress, but does not define a specific constellation of
symptoms, as in Major Depressive Disorder or PTSD.
A wide range of physical and emotional symptoms
and signs can occur among individuals with battle
fatigue including gastrointestinal distress, tremulous-
ness, anxiety, perceptual disturbance, a sense of
unreality, and a dazed look (i.e., ‘thousand-yard
stare’). The diversity and non-specific nature of
presentation distinguish this entity from ASD. Battle
fatigue occurs in combatants who have exhausted
physiological and psychosocial coping mechanisms
with the intense combat experience. Minor injury,
parasitic infection, starvation, heat exhaustion, and
cold injury may decrease the coping resources of a
combatant.
3.4 Medically Unexplained Physical Symptoms
War historians have observed that unexplained physi-
cal symptom syndromes are common sequelae of
combat since at least the US Civil War. Syndromes
such as ‘soldier’s heart’ and illnesses characterized by
physical symptoms attributed (by sufferers) to war-
related exposure to Agent Orange are examples.
Contentious debates between scientists, clinicians,
veterans and their advocates, and journalists persist
around putative etiology. Some argue that the con-
sistent appearance of these syndromes after war speaks
to the likelihood that psychosocial factors contribute
to their etiology.
3.5 Other Psychiatric Illnesses
Depression, anxiety disorders and personality changes
have all been associated with exposure to the trauma
of disaster and war. These psychiatric disorders may
be accompanied by somatic complaints. Such illnesses
have been described in large numbers of persons
exposed neither to war nor other disasters. Therefore,
biological, genetic and environmental risk factors are
all likely involved in the development of these illnesses.

4. Etiology and Epidemiology
4.1 Predisposing Factors
PTSD, other anxiety and depressive disorders, and
physical symptom syndromes are more frequently
diagnosed among women than men in association
with any given stressor. Explanations for this involve
neurobiological and psychosocial factors including
the greater rate at which women seek treatment for
stress-related symptoms and that duration of illness
(e.g., PTSD) may be longer for women and therefore
more likely reach clinical attention. Men are at higher
risk for post-war problems with alcohol and substance
use, and antisocial and violent behavior. Gender-
specific neurophysiological factors as well as cultural
factors are again implicated in these differences.
Level of functioning after combat and disasters also
relates to pre-trauma functioning. Individuals who
function marginally in various roles (e.g., occupational
and social) prior to disaster or combat exposure are at
increased risk for poor functioning after trauma
compared with individuals who were previously
high functioning. Individuals who have successfully
negotiated past traumatic experiences may be resilient
(‘hardened’) in similar future situations. However, if
past traumatic events resulted in PTSD or psychiatric
distress syndromes, subsequent traumatic exposures
may make future episodes of these disorders more
likely.
4.2 Protecti
e Factors
Protective factors may be present to varying degrees in
groups such as military units, police, or firefighters
exposed to trauma. Strong leadership can create
powerful loyalty and interpersonal cohesion with
populations. Potent leaders can create a unit dynamic
wherein leaders are so valued and trusted by members
of the unit as to enable voluntary participation in
extremely high-risk combat or rescue–recovery situa-
tions. A common symptom of poor leadership is the
occurrence of destructive inter-group conflicts and
organizational splits.
An axiom of professional soldiers is ‘we will fight as
we have trained, therefore we must train as we expect
to fight’. If the level of training is high, individuals in
the unit (military or civilian) more frequently trust
ingrained basic principles aimed at supporting one
another in a quest for mission success. Recently,
nonmilitary disaster responders (firemen, police,
physicians and civic leaders) in developed countries
have assembled to train for response to terrorist attack
or natural disaster. Government emergency pre-
paredness agencies such as the US Federal Emergency
Management Agency are increasingly coordinating
such training. The quality and extent of fit between
persons, equipment (e.g., comfort and mobility of
Military and Disaster Psychiatry
chemical protective suits, familiarity with operation of
remotely controlled bomb or mine detectors or per-
sonnel recovery devices), and the environment may
modify stress responses of individuals or communities.
The extent to which the living or working environment
may modify response is evident in studies of those
forced to exist in close quarters for extended periods of
time with only limited contact with the outside world,
such as those aboard ships or submarines. The ‘fit’
between pilot and aircraft as well as between aircrew
members may be improved through specific training.
Finally, the effectiveness (or perceived effectiveness) of
leadership response to crisis is a factor that may
modify community response.
4.3 Precipitating Factors
Precipitating factors are the proximate circumstances
that initiate the various sequelae of trauma. For
disaster responders and military populations, deploy-
ments and peacekeeping missions disrupt families
and are often ‘poorly timed’ with regard to other life
events. High intensity and duration of disaster or
combat exposure relate directly to the likelihood of
psychiatric casualties. Specific experiences, such as
physical injury, witnessing grotesque deaths, torture
or other atrocities place individuals at increased risk
for adverse mental health consequences. Victimization
in the form of rape, harassment, or assault can
precipitate distress reactions in those victimized. Sex-
ual assault is a potent precipitant of adverse neuro-
behavioral changes.
4.4 Mitigating and Perpetuating Factors
Ongoing factors, including the security and safety of
recovery environments, extent of secondary trauma-
tization and—in military populations—rotation
schedules, extent of recognition or compensation for
efforts and belief in the mission effect the rate and
severity of distress symptoms. Symptoms in civilian
victims of war or in the aftermath of disaster may be
mitigated or exacerbated by perceptions of community
leadership’s preparedness for disaster, response to
crisis, recognition of ‘heroes’, and provision of medi-
cal, financial or emotional assistance both immediately
after crisis, and over time.
Nonmilitary, nongovernmental organizations such
as the American Red Cross and the Salvation Army
help to minimize the stress following a disaster. By
attending to basic human needs such as food, clothing
and shelter, they reduce both the psychological and
the physiological effects of the event. In recent years
the Red Cross has developed training for volunteer
health care workers to recognize, minimize and treat
stress responses in disaster workers and victims of
disaster.
9853
Military and Disaster Psychiatry
5. Management and Care Deli
ery
5.1 General Principles
Often disasters or military conflicts shatter the ex-
pectation of a just and safe world within populations
where notions of basic justice and safety are cultural
norms. In such populations, establishing the sense of
safety and expectation of justice is an important aspect
of recovery. Other interventions vary with the stage of
the disaster. Initially, establishing a safe environment,
and managing life-threatening injury and disease
possibilities, such as those resulting from infection or
absence of potable water, can be the most important
psychiatric interventions. Subsequently, identifying
high-risk populations such as disaster workers, fire-
fighters, police, persons at impact zones and children
can focus intervention strategies. Outreach programs
are critical, since disaster victims rarely seek mental
health care. Those who are physically injured are also
at great risk for psychiatric disturbance. Educating
medical and community groups about normal re-
sponses to abnormal events as well as when mental
health referral is indicated is an important part of
outreach programs. Advising community leaders on
expected behavioral problems and needs is required to
ensure availability of resources to care for victims.
This work must involve planning for expected natural
or human-made disasters, and allocating funds for the
care of anticipated victims before disasters actually
occur.
Responsibility for preventive measures, and recog-
nition and treatment of the psychological con-
sequences of such wars and disaster cannot be limited
to the few (if any) available psychiatrists. General
physicians, psychologists and other social scientists
must use their diverse skills to care for disaster and war
victims. They must diagnose and treat disorders
associated with trauma, (e.g., PTSD, depression and
anxiety disorders), provide consultation to medical
and surgical colleagues and other first responders, and
educate community leaders about predictable re-
sponses to abnormal events.
5.2 Military Mental Health Care
The US military has attempted to decrease the
incidence and severity of combat and operationally
induced psychiatric disorders. Mental health teams
are now routinely assigned to US forces in combat and
deployed operations other than war. Each branch
of the US military service has specialized rapid
intervention teams to provide consultation and acute
treatment to units that have experienced traumatic
events. These teams instruct commanders on likely
behavioral responses to stress and recommend lead-
ership actions that may reduce negative responses to
stressful situations. Post-incident debriefings assess
9854
the effect on the unit, and attempt to reduce long-term
consequences of traumatic events. Open discussion of
an incident is believed to foster unit cohesion, facilitate
accurate individual and group understanding, and
reduce the development of psychiatric disorders.
However, in the few groups actually studied, there is
no convincing evidence that acute incident debriefing
has any effect on the later development of psychiatric
illness. Debriefings may be useful in identifying indi-
viduals who require further mental health attention
and decreasing individual isolation and stigma.
Despite the absence of consensus data supporting
their effectiveness, there is increasing interest in
expanding the use of rapid intervention teams. The US
military currently proposes to establish a unified,
multi-service policy on the composition and use of
these teams. This effort follows the widely publicized
‘Gulf War Illness’ complaints of veterans from that
campaign. Some believe that since these symptoms are
largely tied to psychological problems, increased
attention to stress during military operations could
have reduced their incidence or severity.
Different missions, patterns of deployment, and
medical support systems among US military services
pose major problems to the development of a unified
approach to managing operational stress. Armies
typically deploy large units for extensive periods of
time and allocate large amounts of medical assets to
support these units. This medical support includes
specialty services. The US Navy and Marine Corps
deploy smaller units both at sea and ashore. General
medical officers and nonphysician providers furnish
medical support, and specialty care is not routinely
available in the operational theater. The US Air Force
has both short- and long-range missions. Operational
stress management doctrine must consider these
differences. Military physicians also provide medical
and psychiatric assistance to civilian populations in
times of natural and human-made disasters. In ad-
dition to direct patient care, military psychiatrists
consult with community leaders and with civilian
physicians not accustomed to responding to large-
scale physical and emotional traumas.
In the USA, definitive treatment of psychiatric
illness is often provided in the military’s system of
hospitals. Medical care is provided to active duty
personnel and to their families. Other mental health
specialists, nurses, social workers and psychologists
augment this care. Military members who develop
psychiatric disorders while on active duty are eligible
for medical retirement disability pay, and continued
treatment through a system of Veterans Administra-
tion hospitals. Individuals may be separated from
service due to personality problems without disability
payment or ongoing medical care from the military.
Other nations with recent wartime experience, such
as Israel and Croatia, have developed programs to
evaluate and treat soldiers and civilians exposed to
combat. Their experiences are somewhat different

from the US, since they rely much more heavily on
reserve forces. These nations have a more inclusive
social medical infrastructure therefore treatment pro-
grams are less reliant on the military medical system.
Other nations are increasingly confronted with man-
agement of operational stress in peacekeeping and
humanitarian missions. Asian nations that have re-
cently experienced natural disasters and terrorist
events are also studying approaches to evaluating and
treating individuals exposed to trauma.
5.3 Medical Education
Several nations provide medical education specifically
for members of their armed forces. The US Congress
in 1975 authorized The Uniformed Services University
of the Health Sciences (USUHS) to provide medical
education and produce physicians for military service.
USUHS provides a four-year medical degree program
and a number of graduate degree programs in the
basic and clinical sciences. The USUHS Center for the
Study of Traumatic Stress conducts research, and
consults to communities, and federal and international
agencies on matters surrounding individual and com-
munity responses to trauma, disaster and war. Japan,
the UK and Russia are among nations with institu-
tions that teach military specific curriculum to military
medical care providers. As in other nations, these
countries also call to national duty physicians not
specifically trained in military institutions during times
of war or crisis.
6. Future Challenges and E
ol
ing Issues
As political, social, scientific, and technological factors
evolve, societies will change their responses to the
consequences of disasters and wars. Psychiatric prac-
tice associated with wars and disaster has changed
with the evolution of scientific understanding of
illness. In the future, the resources to deal with the
consequences of disaster or war and the relative
importance assigned to dealing with the resultant
injuries and disabilities are likely to be influenced by
political and socio–cultural values.
6.1 Ethical Challenges
The hyper-suggestibility of recently traumatized
individuals has provided an occasion for exercising
political influence and manipulating loyalties. Pro-
viding care in the mass casualty situation raises ethical
questions about the equitable distribution of resources
and the moral values to consider in determining
their apportionment. Governments in trouble have
withheld treatment to minority racial or political
groups—clearly an ethical breach. Since govern-
Military and Disaster Psychiatry
mental terrorism is a common form of terrorism, care
providers and leaders must be sensitive to the possi-
bility that disasters will afford tyrants an opportunity
to manipulate citizens for their own purposes.
To facilitate command assessment of troop health
status, militaries have denied members confidentiality
in medical communication. Mental healthcare pro-
viders must strike a balance between a promise of
privacy that encourages persons to seek care, and
responsible reporting to higher command regarding
situations that pose danger to larger groups. Thus dual
allegiance to both individuals and to the larger
community presents an ethical challenge that must be
negotiated by the military care provider. Persons in
extreme circumstances may behave in ways that they
later view as shameful. Shame may contribute to
posttraumatic symptoms and disturb one’s capacity to
use social supports. Disaster triage is frequently
carried out in large open areas that allow everyone
present to hear what patients say to caregivers. Given
the social stigma assigned to the manifestations of
psychiatric illness it is easy to understand both
patients’ reluctance to communicate and doctors’
reluctance to inquire. Perhaps re-educating the popu-
lation can reduce ethical and therapeutic problems
associated with stigma. However, altering deeply
ingrained cultural expectations is just as challenging as
providing privacy in chaotic triage environments.
6.2 Technological Ad
ances
New technologies in combat will modify the means of
sorting and treating persons with medical and psy-
chiatric injury. Future militaries in technologically
advanced nations are likely to become much smaller,
move rapidly across the battlefield, use advanced
sensors, and direct intense fire across a considerable
distance. These capabilities, coupled with the possible
use of weapons of mass destruction, will likely make
the battlefield more chaotic and inhospitable to human
life. Emergency care and evacuation of those with
disease and injury may become increasingly difficult.
The inability to maintain contact with rapidly moving
units may preclude returning individuals to their
original units. Future military casualties may increas-
ingly rely on care by unit buddies, medics and frontline
leaders rather than specialized medical units or
specialists at hospitals in the rear.
Underdeveloped nations may have limited access to
advanced technologies, so more traditional ways of
organizing medical and psychiatric practice may con-
tinue to be relevant.
The evolution of highly mobile units on widely
disbursed battlefields will decrease the opportunity for
exchanging rested troops from the rear area for those
exhausted by frontline combat. Provision of brief
respite for exhausted troops—a hallmark of man-
agement of battle fatigue—may become impossible
9855
Military and Disaster Psychiatry
as each individual may be performing a critical
specialized task. Small medical units operating within
the area of combat are likely to be eliminated from
this technology-intensive battlefield. While treatment
may by necessity move to the battlefront, medical
specialists at the rear may render triage decisions and
diagnoses through the use of telemedicine communi-
cation technology. Experience has shown that front-
line mental health providers take a pragmatic view of
acute psychiatric symptoms, and tend not to make
hasty formal diagnoses on overstressed troops. Rear-
echelon providers, by contrast, tend to assign formal
psychiatric labels that may be inaccurate and may
stigmatize troops without contributing to treatment.
Rear-echelon mental health specialists in future battles
must address the challenge of providing useful thera-
peutic advice from afar while avoiding meaningless
diagnostic stigmatization.
Advanced technology will have similar implications
for those responding to human-made disasters such as
terrorist attacks especially as terrorists gain increased
access to so called weapons of mass destruction
(chemical and biological agents). Clarifying the roles
of military and civilian responders in terms of triage,
treatment, consultation and education in any joint
response to crisis is another challenge for military and
disaster psychiatrists.
6.3 Cultural Issues
Social scientists note that responses to trauma may be
considered either normal or pathological, depending
on the interested party. Many have expressed fear that
mental health practitioners, motivated by profit, will
try to convince individuals experiencing normal un-
comfortable responses that they need treatment.
Overcoming this fear or the belief that accepting
assistance signals weakness is a challenge in circum-
stances where necessary and available external as-
sistance is rejected by a nation in crisis.
Most individuals exposed to traumatic events de-
serve to be reassured that with return to work,
community and family, they will recover. However,
some individuals (and perhaps some cultures) will
experience greater psychopathologic responses and
more prolonged symptoms following trauma. The
nature of the behaviors and symptoms associated with
trauma response across cultures is still uncertain. The
extent to which social supports, biological–genetic
predisposition, concurrent illnesses, and other political
economic parameters contribute to variability across
cultures is not known. While it appears clear that the
severity of the trauma is important, reliable measures
of severity remain to be determined. Trauma may,
under some conditions, create the opportunity for
personal growth as well, and further understanding
of this potential must also be exploited to reduce
morbidity.
9856
7. Conclusion
Natural and human-made disasters result in traumatic
disruption of societal function. Wars and acts of
terrorism with their attendant large-scale death, injury
and destruction affect populations in much the same
way as massive natural disasters. Whatever the cause,
disasters and military operations leave in their wake
populations experiencing psychological disturbances
that have been described by social scientists, civil
leaders, physicians and other care providers through-
out the ages.
The consequences of exposure to disaster and war
may take the form of psychological disorders such as
PTSD or may manifest as various (and sometimes
more subtle) forms of behavioral change, anxiety or
depression. Symptoms may present at different times
during and after traumatic exposure. Many factors
complicate the evaluation and treatment of neuro-
psychological syndromes in the aftermath of war or
disaster. Resources are overwhelmed, life-threatening
illnesses require immediate treatment, and psycho-
logical casualties are often reluctant to seek assistance.
Progress has been made in identifying the nature of
trauma-related psychological responses. Predisposing,
exacerbating and mitigating factors have been identi-
fied. The value of multidisciplinary preparation and
training for disaster management and the need for
outreach programs have also been demonstrated.
Further study will focus and clarify the roles of
psychotropic medications and various forms of
psychosocial support and psychotherapy in the treat-
ment of war and disaster-related morbidity. With
technological advances and global economic shifts,
the nature of war and other human-made disasters will
change. Military and disaster mental health care
delivery must anticipate such changes to develop
improved methods of prevention, evaluation, and care
for individuals and groups devastated by war or
disaster.
See also: Disasters, Coping with; Disasters, Sociology
of; Military Psychology: United States; Post-traumatic
Stress Disorder; Reconstruction\Disaster Planning:
Germany; Reconstruction\Disaster Planning: Japan;
Reconstruction\Disaster Planning: United States
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Copyright # 2001 Elsevier Science Ltd.
All rights reserved.
Military and Politics
Virtually all nations have some form of military force
for protection against external foes, for international
prestige, and often to maintain internal order. The
relationship between a nation’s political life and its
military is a fundamental and enduring problem which
may be understood as a matter of managing the
boundary between them. Civil authorities desire to
control the military; but, militaries are more effective
when they are professionalized, which requires sub-
stantial autonomy and minimal civilian penetration
into their internal operations (Wilensky 1964).
1. Ci
ilian Control of the Military
The scale of the problem of relations between military
and politics differs between modern democracies and
less well developed and differentiated societies (see
Modernization, Political: De
elopment of the Concept).
In stable democratic regimes, widely accepted political
norms and formal institutional mechanisms serve to
maintain the boundary (see Political Culture). Hist-
orically, standing militaries have been viewed as
International Encyclopedia of the Social & Behavioral Sciences
Military and Politics
contributing to tyranny because of the expense of their
maintenance. In modern times they gain political
influence through symbiotic relationships with the
private enterprises that produce their weapons syst-
ems—the ‘military–industrial complex’ that former
United States President Eisenhower warned against in
1961.
Within democracies, institutions of civilian control
include constitutional, legal, and administrative mech-
anisms such as military budgets and establishments,
civilian confirmation of officer commissions, appoint-
ment of top military officials by civilian authorities,
and prohibitions on military employment for domestic
problems. Even powerful and popular military officers
who exceed existing boundaries may be removed from
their positions by their civilian superiors, as when, in
April 1951, US President Harry Truman summarily
relieved General Douglas MacArthur.
Professional, full-time military, consists of members
who devote all of their time to their duties, minimizing
conflicts of interest. In some regimes, civilian author-
ities worry about militaries with a capacity to compete
with their authority. In both communist and fascist
regimes, specialized political officers have been em-
ployed within military units with lines of authority
parallel to military commanders as a means of en-
suring the latter’s compliance with regime dictates.
However, such institutions are not effective absent
an underlying foundation of well-developed and
widely accepted norms in the broader political culture,
which may take centuries to develop (Landau 1971).
Political norms include general acceptance of military
subordination to civilian authorities and specific pro-
hibitions on serving officers engaging in political
activities such as legislative lobbying or standing for
elected or appointed office. These norms constitute
essentially a social contract about the roles and
functions of civil and military authorities, respectively.
The exact character of this contract tends to be
renegotiated over time.
In democratic regimes, such as Britain, a pattern of
norms developed over centuries in which both civilian
and military bureaucracies were subordinated to the
control of Parliament. In the United States, rep-
resentative political institutions were constitutionally
established before any other, with the result that
control of the military by civilian authority has never
been at issue, nor has the legitimacy of representative
institutions relative to the military (see Public Bureau-
cracies). In developing nations, representative poli-
tical institutions may still have to compete with the
military for legitimacy (Stepan 1971).
Development of separate and effective institutions
for domestic law enforcement and state militias,
combined with firmly established political norms
allowing employment of militias internally only in
extreme circumstances of natural disaster or civil
unrest, have reduced pressures to use military forces
internally.
9857
ISBN: 0-08-043076-7