The traumatic process contains three possible stages: a stage of warning, a stage of impact (immediate reaction), and a post-traumatic stage. While identification of factors that can influence the long term clinical picture (the post-traumatic stage) has been attempted elsewhere, examination has not previously been done to explore the relationship between the severity of stressors and the immediate stress reaction. This paper proposes that gradations of stress (intensity, duration) play a key role at the stage of impact (immediate reaction), which subsequently affects both the short and long-term clinical picture. It also proposes that behavior under threat (reaction to stress) is usually an adaptive behavior, a communication, a part of a dialogue between the survivor and the surrounding environment. In this study, immediate stress reaction was measured in terms of CSR, or combat stress reactions. CSR is defined as a means by which soldiers communicate to the system that they cannot take it any more. CSR symptoms can present clinically in a variety of ways, as psychiatric reactions, accidents, somatic illnesses, behavioral acting out or conduct disorders. Reanalysis of a longitudinal study of 4000 soldiers in World War II was conducted, and the question “what kind of objective stress precedes each type of CSR casualties” was asked. Results indicated that gradations of stress at the stage of impact significantly influenced the clinical picture. Intensive combat typically produced psychiatric casualties and accidents. Moderate Stress tended to result in medical casualties; and prolonged, intermittent combat preceded AWOL and disciplinary manpower drain. A study in Israel, which I conducted after the 1982 war, showed similar results.
Bar-On, R., Solomon, Z., Noy, S., & Nardi, C., (1986). The clinical picture of combat stress reaction in the 1982 war in Lebanon: Cross war comparisons. In N. A. Milgram, (Ed.), Stress and Coping in Time of War, Generalizations from the Israeli Experience. Psychological Stress Series, C. R. Figley, series editor, Brunner/Mazel, New-York.
2.
Beebe, G. W., & Apple, J. W., (1951). Variation in Psychological Tolerance to Ground Combat in World War II, Final Report. National Academy of Sciences, National Council, Division of Medical Sciences, Follow-up Agency, Washington, D.C.
3.
Beebe, G. W., & Debakey, M. E., (1952). Battle Casualties, Incidence, Mortality, and Logistic Considerations. Charles Thomas Publishers, Springfield, Ill.
4.
Belenky, G. L., Noy, S., and Solomon, Z., (1985). Battle intensity, morale, cohesion, combat effectiveness and psychiatric casualties: The Israeli experience. Military Review, 65 (7): 28-37.
5.
Belenky, G. L., Noy, S., and Solomon, Z., (1987). Battle stress, morale, cohesion combat effectiveness, heroism and psychiatric casualties: The Israeli Experience. in Gregory L. Belenky (Ed.), Contemporary Studies in Combat Psychiatry. Greenwood Press, New-York.
6.
Braun, B. G. (1990). Dissociative disorders as sequelae to incest. in Richard P. Kluft (Ed.), Incest Related Syndromes of Adult Psychopathology. Washington, D.C., American Psychiatric Press.
7.
Braun, B. G. (1993). Multiple personality disorder and post-traumatic stress disorder: Similarities and Differences. In J. P. Wilson and B. Rapahel (Eds.), International Handbook of Traumatic Stress Syndromes. New-York, Plenum Press.
8.
Coons, P. M., Cole, C., Pellow, T. A., and Milstein, V. (1990). Symptoms of post-traumatic stress and dissociation in women victims of abuse. in Richard P. Kluft (Ed.), Incest Related Syndromes of Adult Psychopathology. American Psychiatric Press, Washington, D.C.
9.
Drabek, T. E, (1986). Human System Responses to Disaster: An Inventory of Sociological Findings. New-York, Springer Verlag.
10.
Figley, C. R. (Ed.), (1978). Stress Disorders Among Vietnam Veterans, Theory, Research and Treatment. Brunner/Mazel, New-York.
11.
Figley, C. R., (1986). Traumatic stress: the role of the family and social support system. In Figley, Charles R. (ed), (1986). Trauma and its Wake Vol II, Traumatic Stress Theory, Research, and Intervention. New-York, Brunner/Mazel Psychological Stress Series No. 8.
12.
Gal, R., (1987). Combat stress as an opportunity: The case of heroism. in Gregory L. Belenky (Ed.), Contemporary Studies in Combat Psychiatry. Greenwood Press, New-York.
13.
Glass, A. J., (1973). Neuropsychiatry in World War II, Vol II, Overseas Theaters. Mullins W. S. series editor, Office of the Surgeon General, Dept. of the Army, U.S. Army, Washington, D.C.
14.
Herman, J. L., (1994). Trauma and Recovery, Tel-Aviv, Israel, Am-Oved Publishers (Hebrew).
15.
Herman, J. L., (1996). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. In G. S. Everly, Jr. & J. M. Lating, (Eds.), Psychotraumatology: Key Papers and Core Concepts in Post-Traumatic Stress. Mew-York, Plenum Series on Stress & Coping.
16.
Herman, J. L, Perry, C., & van-der-Kolk, B. A., (1989). Childhood trauma in borderline personality disorder. American Journal of Psychiatry, 146 (4): 490-495.
17.
Herman, J. L, & van-der-Kolk, B. A., (1987). Traumatic antecedents of borderline personality disorder. In van-der-Kolk, Bessel A., (Ed.), (1987). Psychological Trauma. American Psychiatric Press, Washington, D.C.
18.
Hobfoll, S. E., and Stephens, M. A. P., (1990). Social support during extreme stress: Consequences and intervention. In Sarason, B. R., Sarason, I. R., & Pierce, G. R., (eds), Social Support: An Interactional View. Wiley and Sons, Wiley Interscience pub., New York.
19.
Janis, I. L., (1969). Stress and Frustration. Harcourt, Brace, Jovanovich, New-York.
20.
Kardiner, A. & Spiegel, H. (1947). War Stress and Neurotic Illness. Hoeber, New-York.
21.
Kluft, R. P. (1984). An introduction to multiple personality disorder. Psychiatric Annals14, 19-24.
22.
Kluft, R. P. (1990). Incest Related Syndromes of Adult Psycho-pathology. American Psychiatric Press, Washington, D.C.
23.
Lazarus, R. S. (1966). Psychological Stress and Coping Processes, New-York, McGraw Hill.
24.
Lazarus, R. S., & Folkman, S. (1984). Stress, Appraisal, and Coping. New-York, Springer.
25.
Lowenstein, R. J. (1990). Somatoform disorders in victims of incest and child abuse. in Richard P. Kluft (Ed.), Incest Related Syndromes of Adult Psychopathology. American Psychiatric Press, Washington, D.C.
26.
Niles, B. L., Newman, E., Erwin, B. A., Fisher, M. L., Kaloupek D. G., Keane, T. M., (1999). Stability and fluctuation of veterans' reports of combat exposure. In Williams, L. M. & Banyard, V. L. (Eds.), Trauma & Memory. Thousand Oaks, California, Sage Publications, (pp. 311-317).
27.
Nijenhuis, E. R. S. (1999). Somatoform Dissociation: Phenomena, Measurement, and theoretical Issues. Assen, Holland, Van Gorcum.
28.
Noy, S. (1987a). Battle intensity and the length of stay at the battle field as determinants of the type of evacuation. Military Medicine, 152(12): 601-601.
29.
Noy, S. (1987b). Combat Psychiatry: the American and Israeli Experience. In Belenky, G. L., (ed), Contemporary Studies in Combat Psychiatry. Greenwood Press, New-York.
30.
Noy, S. (1991a). Combat Stress Reactions. in Gal, R., & Mangelsorf, A. D., International Handbook of Military Psychology. John Wiley, London.
31.
Noy, S. (1991b). Can't Take it Anymore: Combat Stress Reactions. Tel-Aviv, Ministry of Defense Publication (Hebrew).
32.
Noy, S. (2000). Traumatic Stress Situations:Tel-Aviv, Shoken Publishers (Hebrew).
33.
Putnam, F. W. (1989). Diagnosis and Treatment of Multiple Personality Disorder. New-York, Guilford Press.
34.
Putnam, F. W. (1990). Disturbances of the “self” in victims of childhood sexual abuse. in Richard P. Kluft (Ed.), Incest Related Syndromes of Adult Psychopathology. American Psychiatric Press, Washington, D.C.
35.
Sarason, B. R., Sarason, I. R., & Pierce, G. R., (eds), Social Support: An Interactional View. Wiley and Sons, Wiley Interscience pub., New York.
36.
Schneider, R. J. (1987). Stress breakdown in the Wehrmacht: Implications for today's army. in Gregory L. Belenky (Ed.), Contemporary Studies in Combat Psychiatry. Greenwood Press, New-York.
37.
Schnurr, P. P., Spiro, A., Aldwin, C. M., Stukel, T. A. (1998). Physical symptom trajectories following trauma exposure: Longitudinal findings from the normative aging study. Journal of Nervous and Mental Disease, 186 (9), 522-528.
38.
Spiegel, D. (1984). Multiple personality as a post-traumatic stress disorder. Psychiatric Clinics of North America, 7, 101-123.
39.
Spiegel, D. (1988). Dissociation and hypnosis in post-traumatic stress disorders. Journal of Traumatic Stress, 1(1), 17-34.
40.
Spiegel, D. (1990). Trauma, dissociation and hypnosis. in Richard P. Kluft (Ed.), Incest Related Syndromes of Adult Psychopathology. American Psychiatric Press, Washington, D.C.
41.
Terr, L. C., (1996). Childhood Traumas: An outline and overview. In Everly, George S., & Lating, Jeffrey M. (Eds.), Psychotraumatology: Key papers and Core Concepts in Post-Traumatic Stress. New-York, Plenum Series on Stress and Coping.
42.
van-der-Kolk, B. A., (Ed.), (1987). Psychological Trauma. American Psychiatric Press, Washington, D.C.
43.
van-der-Kolk, B. A., McFarlane, A. C., Weisaeth, L. (Eds.), (1996). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New-York, Guilford Press.
44.
Wilson, J. P. & Raphael, B. (Eds.), (1993). The International Handbook of Traumatic Stress Syndromes. New-York, Plenum Press.
