Battle Fatigue, Post-Traumatic Stress Disorder, Combat Stress
Based on Neurophysiology, Biochemistry, and Psychology
With Emphasis on Possibilities for Mitigation
Abstract
“Battle Fatigue”, “Post-Traumatic Stress Disorders”, or “Combat Stress” can be lasting and severe afflictions of returned veterans. The least provocation lets them fall as into a funnel toward mind-sets and memories of combat or accident from which they have difficulty escaping, inhibiting their return to a “normal” world. A sense of emptiness, aimlessness or uselessness after leaving the military service may add to the problem, especially when visible scars or handicaps remain. Basic feelings of “anxiety” may add to their discomfort. Some minor brain impairment (in the hippocampus) may appear worrisome, but the brain may recover. The brain’s neurophysiological mechanism of thought sequencing and focusing indicates possibilities for mitigation of the thought-trapping effect and even possibilities for more positive subsequent focus. Medication and psychotherapy may then be supportive. The finding of new, meaningful, and respected tasks – if not in business or government, then in a not-for-profit or charitable organization – would add to meaning, self-respect, and stability in the “new” lives of veterans. Support by family and community requires sensitivity and creativity – to bring new bonding and positive effects to the veterans’ and their families’ lives.
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Contents
- Introduction
- The Physiology and Functioning of the
Brain:
o
Focusing
and Memory
o
Thought
Sequencing, Habits, Valuation, and Focus
- The Breaking of Habits and Valuations,
Establishment of New Thought Sequence Preferences
- New Focus or Meaning
- A Separate Phenomenon: “Anxiety”
- Medication (Biochemistry) Support
- Psychology Support
- Being embedded in family and work team
- Re-socialization within the community
- Own effort and options
- Conclusions
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Introduction:
As if physical suffering were not
enough, many veterans returning from wars suffer from psychological
stress. The forms of this stress are
variously described as Battle Fatigue (after World War II), Post-Traumatic Stress
Disorder (after the Vietnam War), or Combat Stress (now in
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In neurophysiological terms, the basic difference between these two groups lies in their thought sequencing, focusing, and moods – both possibly interrelated. The term “thought sequencing” is used to describe the course that thought pursues in the mind in a sequence of images or “visualizations”. Among afflicted veterans, some noises, some images, some words, or just some facial expressions lead them to awareness of their afflicted situations or to memories of war or accident. From such focus, it is more or less difficult for them to return to thoughts of normal life and to focus on more fulfilling or pleasant thought sequences, with consequent constructive actions and perceived meaning of life. As is commonly known, thoughts carry with them the burden of associated moods. On the other hand, certain moods lend preference to a certain thought focus.
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The following paragraphs analyze the mental sequencing of thoughts and thoughts’ conditioned course, as well as the possibilities for change. Also analyzed is the supporting role of medication and psychotherapy in changing thought sequencing and mood evolution – and the important role of being embedded in an environment that fosters adaptation and personal strength.
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The Physiology and
Functioning of the Brain:
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Focusing and Memory:
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The human brain contains a number of pairs of nodules, called nuclei,
always one of each type in each half of the brain. The nuclei provide specific control
functions. One of these nuclei is called
the “hippocampus”. It provides the
capability for thought focusing and controls the establishment of memory.
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For a number of years it has been known that individuals suffering from
post-traumatic stress disorder may have a small reduction in the size of their
hippocampus (8 to 12% only). It has not
been clearly established whether those with a naturally smaller hippocampus are
more likely to suffer from PTSD. On the
other hand, animal experiments have shown that high levels of stress hormones
can lead to some atrophy of the hippocampus.
Other researchers have found that the hippocampus can regenerate neural
tissue.
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The above findings indicate that individuals suffering from PTSD should
avoid high levels of stress for some time.
Recovery from hippocampus atrophy effects regarding focus and memory, to
the extent as they may have existed in the first place, could be expected.
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Thought Sequencing
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The website www.schwab-writings.com, in its section “Brain, Mind”, presents two essays, “Creative Thought” and “Mental Creativity”. These essays analyze thought sequencing in terms of neurophysiology. Thoughts occur in the mind in many categories, whether as visual images, words (the inner voice), fragrances, tastes, or in abstract ways, here summarily called “visualizations”. A visualization of the mind is based on the activation of a very large number of related neurons in the brain. These groups of neurons sometimes already contain neurons or are synaptically interconnected with neurons that are included in the group of neurons at the base of other visualizations. In that manner, each visualization may be synaptically connected with many others.
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Thought usually consists of only one activated “foreground” visualization at a time in an ongoing sequence, even when occurring subconsciously – unless the visualization sequence is interrupted by new perceptions. It is postulated (and can easily be verified by experiment) that the strongest synaptic connection is selected for the next sequence of thought in the mind – whereby the strength of the synaptic connection is given by its formation or by the firing rate of the incoming neurons, resulting in a corresponding firing rate of the secondary neurons.
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The strength of a synaptic connection depends on the following factors:
- Habituation (not the “habituation” known in neurophysiology that results in a reduced neural response from repetitive neural stimulation, but the “habituation” in the common sense of the word that lets repetitiveness result in a habit, in this case in a stronger synaptic connection based on synaptic “plasticity”). Synaptic strength through habituation results form the number or rate of prior usage of such connection (as is commonly observable in most people’s thought, speech, or behavior habits).
- Valuation, as in the attributed importance or value of a remembered sequence (a specifically remembered associated number or passage). Value can also be contributed by special nuclei of the brain (e.g., the amygdala) based on specific experiences, as when certain noises are experienced as sequencing to specific danger or pleasure.
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The brain is capable of focusing, thereby preventing thought sequencing from uncontrolled divergence. This focusing capability of the brain leads to thought sequences related to the given focus – for example, a given problem, mental task, or preferred mental activity. Without such focusing of thought sequences, all intellectual work (and, for that matter, a reasonable life) would be impossible. But excessive focus leads to constraints in practical life (e.g., “obsessions” or the disorders discussed here). Thought focusing is accomplished by focus retention (with the aid of the hippocampus area in the brain) and preferential signal enhancement of synaptic connections related to the remembered focus thought. Thereby, the focus-related – and, consequently, enhanced – synaptic connections are selected over the other connections.
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In the case of Battle Fatigue or Post-Traumatic Stress Disorder, certain thought-sequencing habits, valuations, and focus may be deeply imprinted on an individual’s mind by the traumatic intensity of the stress-causing experience and its traumatic consequences. Even when the individual’s mind is on a more normal course for some time, an incidental perception may lead back to the deeply imprinted sequence, from whence it is difficult to escape. This is aggravated when the mind is further burdened with an overwhelming focus related to the traumatic memory.
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The Breaking of Habits and
Valuations,
Establishment of New Thought
Sequence Preferences
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Battle Fatigue, Post-Traumatic Stress Disorder, and Combat Stress are
all partially related to deeply imprinted thought valuations and habits. Certain noises or other impressions bring
traumatic memories with their burdensome connotations. Any mitigation of this predicament
must start with the process of thought valuation change, and must lead to
changes in one’s thought-sequencing habits.
For example, a military person may associate loud explosions with
combat, whereas, to a non-military person, loud explosions may indicate
fireworks and are liked – the louder, the better. In another example, a historian of ancient
Mesopotamian cultures may have the most positive associations with a geographic
area that is now the center of traumatic violence in
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From the point of view of
neurophysiology, the valuations of memories that are imprinted by way of the
amygdala nuclei of the brain are semi-permanent. Throughout evolution, this permanency has
protected animals from repetitive danger and facilitated repetitive benefit
without the need for additional learning.
However, such an imprint can be changed.
Animal experiments have shown (and possibly, also, personal experience)
that persistent, repetitive experience of the opposite consequences can lead to
a change in those amygdala-based valuations.
For example, a noise that previously led to danger can be arranged to
subsequently lead to rewards. While it
provoked flight before, it now becomes attractive. In the case of Battle Fatigue, Post-Traumatic Stress Disorder, or Combat Stress,
careful analysis of each case and carefully selected training exercises can
lead to desensitizing in regard to trauma-related perceptions, even to the
stimulation of positive reactions.
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Similar training can lead to
changes in thought habits – or the pursuit of a new and different “typical”
thought sequence when a critical starting visualization is given. A common example is the pursuit of a path to
work or to home. If either of those
locations changes, a tired person may still begin to go along the old
track. After some time, however, even
subconscious thought connections lead habitually to the new location. Similarly, habitual actions, speech patterns,
or behavior can assume new routines based on new imprints and leading to new
thought sequence habits. Thus, the
starting visualization in thought of Iraq, at first sequencing automatically to
battle visualizations, may be changed to sequencing to more positive
Mid-Eastern or Mesopotamian visualizations.
For example, well-guided return trips to the
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New Focus, Meaning, and
Self-Respect
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Focus change or the establishment of a significant new focus and meaning in life is, possibly, the most important factor in dissolving imprinted thought sequences and in mitigating the effects of Battle Fatigue, Post-Traumatic Stress Disorder, or Combat Stress.
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A businessman may carry his focus on profit and efficiency into much of his private life. A scientist may carry his inquisitive, intellectual analysis into private life. A battle-stressed soldier may carry his focus on his unit’s mission and survival needs well into the period after his return – feeling empty if no longer connected to that world. Focus is difficult to change if it is repetitively reinforced.
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Loss of focus can be felt as
losing meaning in life if it is not supplanted by a new focus of true
significance to the individual. A
meaningful new focus, in combination with the avoidance of the old focus, can
lead to dedication to the new focus, even to aversion to the old focus. Many people – mainly those among the elderly
– are focused on their own ailments and become egocentric. But when focusing on another person, a
grandchild, or an old friend, they become almost liberated from
themselves and gain new meaning in their lives.
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Especially effective in establishing a new focus and meaning in life
could be a new, challenging, and rewarding job in a positively
valued team that is respected in the community. Such jobs may be found in business and
government. The start of a computer-based
business is an option for some. Equally
effective could be a challenging engagement in a charitable cause, advocacy of
a public interest, a new or revived personal connection, or a new hobby.
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In the case of Battle Fatigue or Post-Traumatic Stress
Disorder, careful analysis of each case and carefully selected experiments or
training exercises should lead to new focus in life and, consequently, to
liberation from old focus and to new meaning.
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Some veterans may show not only a degree of aimlessness, but some lack
of initiative and purpose as well – possibly wasting valuable time in
rebuilding their lives. A certain amount
of patience is needed. Healing does take
some time. But there is a risk that new
and unfavorable habits are becoming engrained.
Admonishments and criticism can be counterproductive, especially when
they imply weakness of personality. Such
images may become self-fulfilling. That
same veteran, when fully recovered, may return to his or her original positive,
strong, and “true” personality. (For
further reading, look at the essay: ”Brain, Mind: Human Personality’s Stability, Variability
and Multiplicity” in the Section “Brain, Mind” on the website “www.schwab-writings.com”).
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The task is to let the veteran himself find his way. One may begin by finding fixed-time actions, which bring a positive reward, improve the veteran’s self respect, and demand further action and self-improvement. After some training, this should lead to any of the above-indicated options for a meaningful life – in business, self-employed, in government, or a public interest organization.
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Encouragement and honest recognition – not paternalistic or artificial – are supportive.
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A successful situation could develop if the PTSD-afflicted veteran could find a temporary task in helping or guiding other veterans with more severe recovery problems. But some veterans shy away from that approach, wanting to fully return to a “normal” and successful life of their own.
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One should not overlook the specific problem of young single veterans who long to find a companion for their lives. It is urgent that they retain or gain self-respect and recognition of their attractiveness. As many older people know, certain personality values of warm empathy, liveliness, humor, and other qualities prevail in marital happiness over any physical attributes or their lack. Training for self-esteem in social situations and projection of character qualities is possible.
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Some veterans, upon returning from very intense military service, feel out of place and unhappy in “normal” civilian society. They withdraw, cannot tolerate “normal” family life, seek loneliness – yet are unhappy about being alone. Patience, spousal love, and understanding are needed – humor and plain happiness may help, too. As indicated above, time and opportunity (with proper training) must be provided for new focus, new tolerance, and new valuations to develop. A “buddy”, some friend, or a more distant and trusted relative may be better able to penetrate that shell and give good advice to the veteran than the immediate family members, who may be seen as crowding in on the returning veteran.
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The New York Times, in the
edition of
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A Separate Phenomenon: “Anxiety”
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Battle Fatigue or Battle Stress may begin while still on active duty in a hostile environment, irrespective of having received any wounds by military action or accident. This form of battle stress corresponds to the phenomenon of “anxiety”, which is well known in the civilian world – for example, to people who lost their jobs or went through other serious problems in their lives.
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There are well-established approaches to reducing or resolving anxieties – from simple relaxation exercises (for example, deep breathing or muscle relaxation) to focusing on routine tasks, the concerns of other individuals, positive events, or on humor.
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Severe forms of anxiety require some relaxation by means of temporary medication.
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The afflicted individual suffers not only from the unpleasant feeling of anxiety, but also from a feeling of insecurity, reduced value, and possible incapability to handle the tasks of life in the future – even from fearing mental illness. Such an individual should be assured, however, that anxieties can and will be cured, that they may occur to the strongest individuals, they are not an indication of mental illness and do not interfere with any mental capabilities if treated properly – and if the afflicted individual shows a degree of discipline in struggling on and not giving up.
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Anxieties need patience. It may take years for all the symptoms to disappear.
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Since anxiety is a common discomfort among many people, any good medical practitioner in the field of psychology should be able to advise on effective exercises and prescribe the right amount of medication – for a limited time only.
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It is important that the afflicted individual retain his or her self-confidence and initiative in order to resolve this unpleasant and quite burdensome – but not dangerous – and only temporary inconvenience.
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Medication (Biochemistry)
Support
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Battle Fatigue, Post-Traumatic Stress Disorders, or Combat Stress are
often found in combination with, or in consequence of, physical trauma. This can lead to sleep deprivation and focus
fixation. Therefore, not only medical
treatment of the physical impairment, but also a general nerval stabilization,
is necessary for any approach to changes in thought sequencing and focus.
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Mood changes can
lead to thought and behavior changes.
There are well-known, more or less subtle biochemical medical approaches
to mood modification. Addictive drugs
are the greatest temptation – and the most devastating – danger in such
situations. Pharmaceutical products,
chosen and used in restraint under the supervision of an experienced medical
specialist in that field, may be necessary, however – at least for a limited
time.
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Psychology Support
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Many psychological problems remain even after treatment with
psycho-pharmaceuticals. This can be
explained by the retention of thought habits and focus. Consequently, medical treatment has to be
supplemented by psychological treatment – that must be at the core of case
analysis and exercise definition for thought sequence and habit modification.
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Being Embedded in Family and
Work Team – Marital Problems
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A psychological vacuum occurs when a veteran of war is taken out of the
intense team coherence that is typical of battle environments. On the other hand, psychological “crowding”
occurs to families or spouses who had to fend for themselves and their children
upon the return of their offspring, partner, or parent from active duty when he
or she wants to take charge – while possibly not being very good at it. Then family or marital problems may occur.
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There should be a transitional period before a long-term solution to
these problems is found.
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During the transitional period, warm love, the rebuilding of bonds,
tolerance, and mutual recognition are paramount. Human harmony and happiness are more
important than being in charge – or not knowing what to do with oneself. A harmonious transition can lead to a more
successful long-term solution and leave personalities and families intact.
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Transitional periods have to evolve into sustainable and creative
long-term solutions.
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For the family or spouse who stayed behind, this implies primarily a reasonable
sharing of territory, tasks, and resources with the returned veteran – along
with full mutual respect, which projects the assurance of belonging to the
returning veteran.
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For the returned veteran, this means finding a new sense of belonging,
a new role in the family and in life, a new occupation, a new work environment,
a new contribution to personal or family income, to common well-being, and to
society.
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Adjustment problems for all concerned arise when a behavior of
initiative and focus is being intensely overplayed by the returning
veteran. More often, however, initiative
and focus may both be lacking to some degree while the veteran is still
suffering from post-traumatic stress disorder.
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Where are the reasonable limits of patience and restraints from
interference? Instead of finding the
ideal solution immediately, any small step toward positive engagement is likely
to be preferable – the resulting dissatisfaction augmenting subsequent
initiative. Too much pushing may further
reduce adjustment or initiative. If
there is no discomfort with the initial situation, there may not be enough
motivation for improvement.
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If no balance can be found, an outsider – a “wise” senior relative, an
experienced social worker, a practical psychologist, an experienced marriage
councilor, a minister of the church, or a good friend of the veteran – all may
provide counsel.
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Re-socialization within the
community
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The thoughts for this section were contributed by Dick Murphy, a
veteran of the Navy, a graduate of the
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Many veterans returning from battle environments may have joined the
armed services right after high school.
Their most important formation may have occurred during active service
in a military community and environment very different from the civil community
and environment where they now have to find their future. Assistance can and should be provided to
facilitate this adjustment. Creativity
and initiative is needed to provide such assistance.
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In one excellent example, a town organized a program for returning
veterans for re-entry into learning and re-socialization with the younger
segment of the community. The
high-schools offered a one-year abbreviated program to recap the whole
high-school curriculum. Some social
functions were shared with the regular senior class. This program facilitated companionship with
other veterans, job search, subsequent continuation of learning through entry
into colleges, the finding of new friends among the young people, and the
adaptation to life in the civil community.
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The offering of internships in local businesses and professional or
service organizations, community installations, government offices, or
charitable organizations would be another helpful idea.
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Each community could arrive at creative and effective ideas related to
their specific situation.
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Ultimately, these activities should not be “charitable”. They should respect the accomplishments of
the veterans and lead to their independent well being in dignity.
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Own Effort and Options
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The unrelenting pursuit of unwanted and burdensome thought patterns is
a phenomenon well known among spiritual groups in many cultures throughout
history. Buddhist monks want to be free
of all distracting thoughts. Christian
monks and hermits want to be free of “worldly temptations”. Modern businessmen or women just want to
relax from overburdening obsessions and regain a balanced view of their lives.
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Several Eastern meditation techniques are quite effective in reducing
unwanted thought. The attribution of
spiritual visualizations or total withdrawal is neither necessary nor
beneficial. Simple mind control
techniques, as offered by a number of more practical yoga methods, are
sufficiently effective. The most
primitive form of such an exercise is the visualization and counting of a herd
of sheep in order to fall asleep. Better
methods were developed for modern businessmen or women to relax or concentrate. Such exercises can be done in guided groups
or, individually, at home. In either
case, the concerned individual must make some personal effort to pursue the
prescribed thought exercises – being rewarded with relaxation and inner peace –
to be ready for a better pursuit of life.
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Western monastic rules and exercises were less developed. Following their simplest rule, “do
not look at what distracts you”.
Just refuse to look or listen to impressions that provoke an old or
bothersome obsession. Just deny your own
thoughts of undesirable character their pursuit.
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A complementing and effective rule is the initiation and pursuit of
desirable thought patterns when undesirable ones are threatening. This is the reason why some monks have to get
up very early in the morning for short spiritual prayer session in their chapel
– or priests have to walk around in the courtyard reading the prescribed book
of thoughts and prayers. The practical
application here: make it a habit
of starting the day with positive thoughts along the line of the life
you really want to lead. Repeat
this re-concentration on “positive” thoughts several times during the day. Have a book available of positive thoughts that
you can read in small increments several times during the day to help
you to re-focus, to re-charge your batteries.
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Yes, all of these exercises do take personal effort and a degree of
discipline, but this is what you can do for yourself – possibly
beginning in group sessions and, later, supported by your family and friends.
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Conclusions
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Battle Fatigue, Post-Traumatic Stress Disorder, or Combat Stress should
not be treated with medication, psychoanalysis, and support group approaches
only. Ultimately, the afflicted
individual must be liberated from the nerval thought sequence and
focus-imprinting that always leads back to the trauma experience, consequently
keeping the afflicted individual mentally confined. Neurophysiology indicates that this traumatic
imprinting is found in three areas: in
the strength of the coupling between imprinted thought sequences and lack of
alternative couplings of equal or higher strength; in the valuation of prior impressions and
lack of higher valued alternative impressions;
and in the strength of imprinted focus and lack of new focus. Careful analysis of each case and
well-designed exercises can lead to mitigation.
Anxieties can be defused. New energy
vitalized and focused. Obsession
dissolved.
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Additionally – and, possibly, most importantly – personality forces have to be vitalized and an approach found to a meaningful and fulfilled life in self-respect and social integration. A transitional period should allow for new bonding and embedding in family, social groups, and the community. A step-by-step building of a new place in society must follow – providing income, recognition, and constructive contribution, whether in a practical occupation, in business, government, or a charitable organization.