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Combat Operational Stress
Psychological health is a leadership responsibility

Physical wellness is tied to combat readiness, and combat readiness is tied to leadership. When Marines are injured in training or combat, we do all we can to quickly evacuate them for treatment and assist in their recovery. But psychological wellness is also central to combat readiness; yet, some wrongly tell subordinates our Corps does not care about their psychological health - that it is better to return to Iraq without first looking after their welfare. This view is contrary to Marine Corps policy and it runs counter to the principle that Marines take care of our own.

Similarly, there is often a stigma attached to psychological health issues (combat operational stress, PTSD, etc.). A recent Department of Defense Task Force on Mental Health report noted that nearly half of all Marines deployed to Iraq or Afghanistan thought their leadership would treat them differently if they sought counseling. This finding suggests a leadership failing at multiple levels. At the individual level, whether we stigmatize something is a personal choice. And at the unit level, it is an unfortunate example of accepting reduced combat effectiveness. Marines bear a responsibility to address this stigma. Ask yourself: "Is a squad at peak combat effectiveness when its leader is afraid to address mental health issues associated with earlier tours to Iraq?" I don't think so.

Combat affects us in various ways. Afterwards we need time to heal and many things influence our recovery. When we are physically wounded, our recovery is influenced by the type and severity of the injuries, infection, age, etc. There is also a psychological burden associated with combat. That recovery period is influenced by our individual experiences, biological and psychological make-up, age, relationships, etc. But just as physical illnesses or injuries can be treated or repaired, so too can psychological injuries.

Marines are uncompromising in our belief that we take care of our own. Yet, failing to support Marines who should see mental health professionals for post-combat stress issues and stigmatizing psychological wellness violates this practice. We do ourselves, our Marines, our families and friends, and our Corps a disservice when we fail to exercise our leadership responsibilities. Marines take care of our own, and psychological health is a leadership responsibility.

There are many ways to assist yourselves, your Marines and your families during the post-combat psychological recovery period. These include unit surgeons, chaplains, the SACO, the Naval Hospital, the Deployment Health Clinic, Military OneSource, and various MCCS programs, to include Marine & Family Services Counseling Services, CREDO and CSACC. For information on these and other civilian and military resources, see
Marine Corps MCCS Counseling Services.

Useful Information/Resources
What is Posttraumatic Stress Disorder (PTSD)?

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening.

Anyone who has gone through a life-threatening event can develop PTSD. These events can include:

Combat or military exposure
Child sexual or physical abuse
Terrorist attacks
Sexual or physical assault
Serious accidents, such as a car wreck.
Natural disasters, such as a fire, tornado, hurricane, flood, or earthquake.

After the event, you may feel scared, confused, and angry. If these feelings don't go away or they get worse, you may have PTSD. These symptoms may disrupt your life, making it hard to continue with your daily activities.

What treatments are available?

Today, there are good treatments available for PTSD. When you have PTSD dealing with the past can be hard. Instead of telling others how you feel, you may keep your feelings bottled up. But talking with a therapist can help you get better.

Cognitive-behavioral therapy (CBT) is one type of counseling. It appears to be the most effective type of counseling for PTSD. There are different types of cognitive behavioral therapies such as cognitive therapy and exposure therapy. There is also a similar kind of therapy called eye movement desensitization and reprocessing (EMDR) that is used for PTSD. Medications have also been shown to be effective. A type of drug known as a selective serotonin reuptake inhibitor (SSRI), which is also used for depression, is effective for PTSD.

Resources

Please follow any of the links below for more information on PTSD and resources available to servicemembers and their families.

MCCS Counseling Services
Military One Source
National Center for PTSD

Combat Stress Series
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Forget the old stigmas. Seeking treatment for injuries sustained while deployed doesn’t make a weaker Marine. In fact, problems that are ignored could potentially be worse in the long run.

It’s easy to recognize a gunshot or shrapnel wound. The physical scars will stay with a Marine for a lifetime. The Wounded Warrior Center here is able to assist those Marines, while time and physical therapy can help them rehabilitate. But what about injuries that can’t be seen?

Post Traumatic Stress Disorder and traumatic brain injuries are some of the harder-to-spot injuries that combat veterans face.

Because there is no visible physical wound, these problems are more difficult to diagnose, said Dr. John Sentell, chief of Mental Health Service at the Martinsburg Veterans Affairs Medical Center.

When a improvised explosive device detonates near a service member, the concussion from the blast can damage the brain by jostling in the skull, Sentell said.

The result can be loss of short-term memory, decreased concentration and sudden personality shifts.

For some service members, it’s not until months after their deployment ends before they realize they might have a problem.

Recently, Post Traumatic Stress Disorder has moved into the national media spotlight.

PTSD is a condition that develops after someone has experienced a life-threatening situation, like combat, which has caused an emotional reaction involving intense fear.

People with PTSD have the same three kinds of symptoms for months after the incident: envisioning the event over and over, avoiding things that remind them of the event and feeling “keyed up” or on edge all the time.

“You’re not with the guys that you spent everyday for the last seven months with anymore,” said Navy Seaman Apprentice Daniel Fox, a 23-year-old corpsman from Boston. “It’s a lot of adjustments, especially if you’re working with new people.”

The Marine Corps has made help easily available in light of the number of service members returning from Iraq or Afghanistan with PTSD problems.

If a Marine doesn’t feel comfortable talking to a corpsman or peers about receiving help, Marine Corps Community Services has counselors available.

Once a Marine is treated and leaves the military, his record is sealed, Cook said. So Marines don’t have to be worried about a medical record of PTSD following them around.

But a bigger worry, Cook said, would be letting the untreated disorder affect them for the rest of their life.
Combat related stress has become an issue for veterans returning from iraq or Afghanistan. receiving medical attention for Post Traumatic Stress is vital to the long-term recovery process.

The condition is an anxiety disorder that can occur after a traumatic event.

Most military medical practitioners agreed that service members who seek treatment upon returning home have a better chance of living a more stable, less anxiety-filled life.

“Usually family members are the first ones to notice signs of PTSD,” said Cmdr. David M. Oliver, 1st Marine Division Psychiatrist. “Anxiety, nightmares, insomnia and isolation from friends and family are some signs of PTSD.”

There are several ways to treat Marines with combat stress, including psychotherapy, grief therapy, and the use of different medications, Oliver said.

Utilizing the treatments, patients learn relaxation skills, good sleep habits and discuss what happened while deployed, Oliver continued. These methods help Marines understand their disorder by helping them see all the good things they accomplished and not focusing on the bad, Oliver said.

Specific treatments are used for each individual patients needs.

“Psychotherapy hopefully teaches the patient ways to relax and ways to prevent anxiety from occurring,” Oliver said.

Depending on the patient and severity of anxiety, different methods are modified to accommodate the patients personal needs.

“The stress may worsen or improve over time even if they aren’t treated. The symptoms could worsen because they may focus on their combat experiences and let the other aspects of their life slip,” Oliver said.

“A way to combat PTSD is to have a realistic training like Mojave Viper. The training puts you in situations that may help develop resilience to combat stress,” Oliver said.

Once a Marine is treated, they may find it easier to carry out a normal life, though Marines can have relapses, usually due to high stress situations. Oliver emphasized that service members are less likely to experience anxiety relapses with treatment rather than without.

There are Marine Corps Community Services counselors, military psychiatrists, and chaplains who make themselves available to service members in need of counseling.

For more information, contact MCCS-CP counselors at (760) 725-3841.
A small dose of small-unit leadership can help Marines cope with post-deployment stress.

Post-deployment stress is an anxiety condition that can occur after a traumatic experience.

Marines returning from deployment should use their chain of command for guidance.

“Look for words of advice, leadership, what to do and a sense of relief,” said Pfc. Ricardo A. Ortega, a rifleman with 1st Battalion, 5th Marine Regiment, 1st Marine Division. “Be able to speak your mind and a noncommissioned officer will listen to you.”

The best way to reach people with post-deployment stress is in group settings, said Ortega, 23, from Houston. Everyone that has problems can get together and talk, and the NCO can give advice and talk within the group, said Ortega.

Knowing your Marines and looking out for their welfare is part of the 11 Marine Corps leadership principles.

This particular leadership trait can prove useful for small-unit leadership to recognize and seek treatment for Marines with post-deployment stress.

“You can always tell by how outgoing they are and if they are able to handle their job,” said Staff Sgt. Miguel R. Saenz, a platoon sergeant with Battery T, 5th Battalion, 11th Marine Regiment, 1st Marine Division. “Their work ethic changes, the way they hang out with other Marines and they want to be left alone.”

Most NCOs agree that their job is to mentor junior Marines and to instill self confidence in them.

“Sit down with them and explain why things happen and how things work,” said Saenz, 30, from Ratcliff Ky. “It lets them see what they have to do to get back into the fight.”

The small-unit leadership must instill confidence in the Marines who need help, so that they can continue to do their job effectively.

The senior enlisted Marines teach specific ideas on how the small-unit leadership should handle their Marines with post-deployment stress.

The hard part is getting the Marines to come forward and say that they need help, said Sgt. Maj. Dennis W. Reed, the I Marine Expeditionary Force sergeant major.

“Sit down and start talking, get the Marine to relax and talk about what’s going on in their life,” Reed said.

Utilizing small-unit leadership to handle the stress concerns is vital to keeping Marines ready to fight.

Reed said to stress the fact that there are no stigmas involved and establish that they’re not the only Marines coping with this problem. There is no harm or foul to come forward and ask for help.
Finding help coping with combat stress might just be easier than you think.

Whether a unit is in a combat zone or on base, there are specific group of service members whose only job is to take care of Marines.

The corpsmen.

Instead of jumping straight to a psychiatrist, seeking professional treatment through the sailors serving alongside Marines is a sure-fire way to start down the path of recovery.

If a Marine is experiencing symptoms of combat stress that affect his daily life, the first line of defense is his Aid Station, said Navy Seaman Apprentice Daniel Fox.

“There’s such an opportunity for help that people shouldn’t be falling through the cracks anymore,” said Fox, 23, from Boston.

After speaking with the independent duty corpsman (usually a Petty Officer 1st Class or Chief Petty Officer), the Marine can be referred to a psychologist at one of the Mental Health centers on base.

“Those guys have seen this a thousand times,” said Petty Officer 1st Class Jimmy Cook, independent duty corpsman with 1st Marine Division aid station. “They know how to handle every part of it.”

A Marine in treatment will spend considerable amount of time talking out the issues with a psychologist before he is referred to a psychiatrist.

The psychiatrist is a mental health professional qualified to dispense prescriptions to ease the service member in need, but as a last resort.

Drugs aren’t an immediate fix or the best solution, for Marines dealing with post-deployment stress, corpsmen say.

A service member with a problem can usually work out his issues by talking about them, rarely are drugs needed, said Cook.

Marines and sailors shouldn’t feel like they’re alone or lost, said Navy Capt. Joseph E. Sarachene, executive officer for the Naval Hospital Camp Pendleton.

Instead, know that the professionals think of it as a “team approach” to help the service member recover.

It’s important for a Marine not to feel his options are limited, Sarachene said.

There is never only one possible solution.

Once a Marine is treated and leaves the military, his record is sealed, Cook said.

So Marines don’t have to be worried about a medical record of PTSD following them around.

But if a service member is getting treatment through the Aid Station and their symptoms are not going away, they may want to look to another organization for help, said Sarachene.

Marine Corps Community Services offers counselors for Marines, should they not feel comfortable approaching any friends serving alongside them.

“The most important thing is to make sure they get the appropriate help needed,” said Sarachene.

For more information on this topic or others relating to Post Tramatic Stress Disorder, contact Marine Corps Community Services-Camp Pendleton counselors at (760) 725-3841.