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FIELD MANUAL
NO. 22-51

HEADQUARTERS
DEPARTMENT OF THE ARMY
Washington, DC, 29 September 1994

PREFACE

CHAPTER 1. OVERVIEW OF COMBAT STRESS CONTROL

1-1. Introduction
1-2. Combat Stress Control
1-3. Scope of Combat Stress Control
1-4. Historical Experience
1-5. Effects of Battle on Soldiers, Units, and Leaders
1-6. The Potential High-Tech Battlefield
1-7. Responsibilities for Controlling Combat (Conflict) Stress
1-8. Primary Responsibility--Combat Stress Control/Mental Health Personnel
1-9. Effective Combat Stress Control Program

CHAPTER 2. STRESS AND COMBAT PERFORMANCE

Section I. Stress Terminology and the Stress Concept

2-1. Introduction
2-2. Understanding of Interactions
2-3. Discussion of Physical Versus Mental Stressors
2-4. Positive Stress
2-5. Relationship of Stress to Task Performance
2-6. Fatigue
2-7. Stages of Adaptation to a Threatening Situation

Section II. Combat Performance and Combat Stress Behaviors

2-8. Phases of Adaptation to Combat
2-9. Combat Stress Behaviors
2-10. Overlapping of Combat Stress Behaviors
2-11. Post-Traumatic Stress Disorder

CHAPTER 3. POSITIVE COMBAT STRESS BEHAVIORS

3-1. Introduction
3-2. Increased Alertness, Strength, Endurance--Exhilaration
3-3. Gamesmanship and Sportsmanship
3-4. Sense of Eliteness and Desire for Recognition
3-5. Sense of Purpose
3-6. Increased Religious Faith
3-7. Personal Bonding
3-8. Horizontal and Vertical Bonding
3-9. Unit Identity
3-10. Unit Cohesion
3-11. Heroism
3-12. Positive and Misconduct Stress Behaviors--The Double-Edged Sword

CHAPTER 4. COMBAT MISCONDUCT STRESS BEHAVIORS

4-1. Introduction
4-2. Indications of Potential Misconduct Stress Behaviors
4-3. Behaviors of Primary Concern to Command and the Law of Land Warfare
4-4. The Misconduct Stress Behavior of Opting Not to Take Prisoners
4-5. The Misconduct Stress Behavior of Killing Enemy Prisoners
4-6. The Misconduct Stress Behavior of Mutilating Enemy Dead
4-7. The Misconduct Stress Behaviors of Torturing Prisoners, Using Excessive Force or Brutality, and Killing Animals
4-8. The Misconduct Stress Behaviors of Looting, Pillage, and Rape
4-9. The Misconduct Stress Behavior of Fraternization
4-10. The Misconduct Stress Behavior of Killing Noncombatants
4-11. The Misconduct Stress Behavior of Fighting with Allies or United States Forces
4-12. The Misconduct Stress Behavior of Being Absent Without Leave or Deserting
4-13. The Misconduct Stress Behavior of Refusing to Obey an Order
4-14. The Misconduct Stress Behavior of Threatening to Kill or Killing Unit Leaders or Other Soldiers
4-15. Misconduct Stress Behaviors of Special Concern to the Medical System (Along with Command)
4-16. Malingerers
4-17. Self-Inflicted Wounds
4-18. Drug and Alcohol Abuse
4-19. Factors Which Increase Misconduct Stress Behavior
4-20. Factors Which Protect Against Misconduct Stress Behavior

CHAPTER 5. BATTLE FATIGUE

5-1. Introduction
5-2. Contributing Factors Which Cause Battle Fatigue
5-3. Signs/Symptoms of Battle Fatigue
5-4. Labeling of Battle Fatigue Cases
5-5. Severity of Symptoms and Response to Treatment

CHAPTER 6. POST-TRAUMATIC STRESS DISORDER

6-1. Introduction
6-2. Psychologically Traumatic Events
6-3. Identification and Treatment of Post-Traumatic Stress Disorder After the War
6-4. Combat Stress Control (Mental Health) Personnel Responsibilities

CHAPTER 7. STRESS ISSUES IN ARMY OPERATIONS

7-1. Introduction
7-2. Overview of the Challenges
7-3. The Potential Battlefield
7-4. Army Operations Doctrine: Implications for Combat Stress
7-5. Endurance/Staying Power on the Battlefield

CHAPTER 8. STRESS AND STRESSORS ASSOCIATED WITH OFFENSIVE/DEFENSIVE OPERATIONS

8-1. Introduction
8-2. Offensive Operations
8-3. Battle Fatigue and Battle Fatigue Casualties in the Offense
8-4. Defensive Operations
8-5. Stress, Battle Fatigue, and Battle Fatigue Casualties in the Defense

CHAPTER 9. COMBAT STRESS CONTROL IN OPERATIONS OTHER THAN WAR

9-1. Introduction
9-2. Support for Insurgency Operations
9-3. Support for Counterinsurgency Operations
9-4. Combatting Terrorism
9-5. Operations Other Than War (Peacetime Contingency Operations)
9-6. Stress Problems of Military Operations Other Than War

CHAPTER 10. WAR AND THE INTEGRATED (NUCLEAR, BIOLOGICAL, AND CHEMICAL) BATTLEFIELD

10-1. Introduction
10-2. The Battlefields of War
10-3. The Integrated (Nuclear, Biological, and Chemical) Battlefield

CHAPTER 11. PREVENTION OF BATTLE FATIGUE CASUALTIES AND MISCONDUCT STRESS BEHAVIORS

11-1. Introduction
11-2. Leader's Role in Training Battle Fatigue Prevention
11-3. What the Members of the Unit Can Do to Control Stress
11-4. What the Individual Can Do to Control Combat Stress
11-5. Prevention of Misconduct Stress Behaviors

APPENDIX A. LEADER ACTIONS TO OFFSET BATTLE FATIGUE RISK FACTORS

A-1. Home Front
A-2. New Soldier
A-3. First Exposure
A-4. Unit Casualties
A-5. Passive Posture, Defenseless to Attack, or Hit By Friendly Fire
A-6. Immobility
A-7. Lack of Information/Support
A-8. Nuclear, Biological, and Chemical Weapons
A-9. Deprived of Sleep
A-10. Physically Run-Down
A-11. Inadequate Fitness
A-12. Older Veteran or Short-Timer

APPENDIX B. ORGANIZATION AND FUNCTIONS OF ARMY MEDICAL DEPARTMENT COMBAT STRESS CONTROL UNITS

B-1. Introduction
B-2. Army Medical Department Combat Stress Control Program
B-3. Basic Tenets of Army Medical Department Combat Stress Control
B-4. Organizational and Operational Concept for Army Medical Department Combat Stress Control
B-5. Combat Stress Control in the Continuum of Army Life

APPENDIX C. UNITED STATES ARMY BANDS

C-1. Morale Support
C-2. Army Bands as Effective Tools
C-3. Army Bands in Combat
C-4. Mission
C-5. Troop Gatherings and Activities
C-6. Military Ceremonies
C-7. Religious Ceremonies
C-8. Music in Support of Psychological Operations

APPENDIX D. THE UNIT MINISTRY TEAM'S ROLE IN COMBAT STRESS CONTROL AND BATTLE FATIGUE MINISTRY

D-1. Introduction
D-2. Effects of Stress
D-3. Team Relationship
D-4. Spiritual Values
D-5. Team Support
D-6. Reintegration

APPENDIX E. EXAMPLE LESSON PLAN

GLOSSARY

REFERENCES

INDEX

DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.

*This publication supersedes FM 26-2, 29 August 1986.

PREFACE

This field manual (FM) provides information for all leaders and staff on the control of combat stressors and the prevention of stress casualties. It identifies the leaders' responsibilities for controlling stress and recognizing the effects of stress on their personnel. It reviews Army operational doctrine for war and operations other than war. It identifies likely stressors and recommends actions for leaders to implement for the prevention and management of stress. The manual describes the positive and negative combat stress behavior associated with stress and provides leader actions to minimize battle fatigue risk factors. It provides the many different military branches and disciplines with a common conceptual framework, knowledge base, and vocabulary so they work together toward controlling stress. It provides information on how stressors and the stress process interact to improve or disrupt military performance. It identifies the supporting role of special staffs such as the chaplain and the Judge Advocate General. This manual also identifies the responsibilities of medical personnel for prevention, treatment, and management of battle fatigue and stress-related casualties.

The proponent of this publication is the United States (US) Army Medical Department Center and School (AMEDDC&S). Send comments and recommendations on Department of the Army (DA) Form 2028 directly to Commander, AMEDDC&S, ATTN: HSMC-FCD, Fort Sam Houston, Texas 78234-6123.

This publication contains copyrighted material.

Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively to men.

The use of trade names in this publication does not imply endorsement by the US Army, but is intended only to assist in the identification of a specific product.

ACKNOWLEDGMENT

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Third Edition, Revised. Washington, D.C.: American Psychiatric Association, 1987.