Leaders Guide - Combat and Operational Stress

Grief encompasses all changes in mental function and behavior resulting from the loss of someone or something that is deeply cared about. In combat and other military operations, losses can result from casualties within the unit, or from a death or relationship break-up back home. The physical and mental components of grief have, in the past, usually been considered “normal” responses to losses because they occur in some form in everyone who experiences a significant loss, and significant losses are inevitable in life. However, there is accumulating evidence that the changes in the brain, body, and mind that accompany grief can be virtually identical to those which accompany stress injuries due to trauma or fatigue, and that the long-term health consequences of unhealed grief can be as significant. As with other stress injuries, the wounds of grief can also impair mental functioning in a number of ways that may impact on performance during combat and other military operations, and on long-term health. Grief is a stress injury that deserves great respect and care.

Everyone experiences and expresses grief differently. There is no “right way” or “wrong way” to grieve and heal from a loss. However, successful identification and management of grief requires Marine leaders to be aware of two possible indicators: (1) losses that may have a high potential for producing more severe and persistent grief symptoms and behaviors — known as “complicated grief,” and (2) the symptoms and behaviors that most commonly accompany grief.

Marine leaders should keep always in mind the fact that deaths or serious injuries in the unit affect everyone in the unit, although Marines closest to the lost unit member (closest to the center of impact of the loss) will likely be more deeply wounded by the loss. Furthermore, normal processes of healing from grief are almost always shared by the community impacted by the loss. Grief is a biological and psychological healing process in each individual, but it is also a social healing process within a group of affected individuals. Therefore, leaders must attend to the individuals who appear to be the most affected by grief at the same time as they attend to the unit as a whole. Leader actions for grief include: (1) applying psychological first aid for individuals, (2) applying psychological first aid for units, (3) assessing the need for professional care, and (4) mentoring back to full duty and function.

Unit-level interventions after losses are the responsibility of unit leadership, at all levels — including unit chaplains and medical personnel — with assistance and support of mental health personnel outside the unit as needed. Routine psychological debriefing in units, such as Critical Incident Stress Debriefing (CISD), is not encouraged because it is not believed to be helpful, and it may be harmful for certain individuals. The following are steps for psychological first aid for units affected by losses:

It is unusual for Marines to require or ask for professional care because of grief, and most people never seek any assistance for healing from a loss, except from a trusted minister, friend, or family member. Grief normally becomes less troubling over time, as the individual mourns the loss. However, the following are indications of grief that is not healing fully, and may benefit from professional care:

A Marine you know is having problems denies it: Remember that most people are ashamed of having emotional problems of any kind, especially in combat or operational situations in which everyone is stressed. In order to admit to themselves or anyone else that they need help, stress-injured Marines have to believe that asking for help is not an admission of failure or weakness, and that they will be better off in the long run if they ask for help. You can make it more OK for a Marine with stress problems to admit to them if you disclose stress problems that you, yourself, or that other respected Marines have experienced. Remind the Marine that although there is a small chance that getting help for a stress injury will hurt their career or future employability, there is a much greater chance that not getting help when needed will hurt their health or safety, as well as the safety of their fellow Marines. If a Marine with stress injury symptoms refuses to talk about them or to consider getting help, honor that decision unless the Marine’s potential risk to themselves or others requires you to order the Marine to submit to a mental health evaluation in accordance with DoDD 6490.1.
You send a Marine for help, but you’re not sure they’re getting the right kind of help: Although chaplains, counselors, physicians, psychologists, and psychiatrists all have skills to help Marines recover from stress injuries of all kinds, not all helping professionals are equally trained and experienced in identifying such problems and providing help for them. The last time our country was in a sustained conflict, not as much was known about complicated grief and its effects on the body and mind; there is a great deal about caring for operational stress injuries that has only recently been learned or developed. If one of your Marines seeks care from a professional who seems not to be helping as much as expected or desired, you have a few options. First, talk to the helping professional and express your concerns or questions about their plan of care. Tell them what is desired. Second, if direct liaison with the helping professional doesn’t help, seek help for your Marine through another of the many available portals of care (listed elsewhere in this guide). Third, contact one of the leaders of a helping professional community or service for further assistance and guidance.