Worry In Warriors

Worry in Warriors Lt Col Md Rabiul Alam AMC MBBS, MCPS, FCPS (Anaesthesiology)

Classified Specialist in Anaesthesiology

INTRODUCTION Worry denotes a strong feeling of anxiety. In the 16th century the word worry began to be used in the sense „to harass, as by rough treatment or attack,‟ or „to assault verbally,‟ and in the 17th century the word took on the sense „to bother, distress, or persecute.‟ It was a small step from this sense to the main modern senses „to cause to feel anxious or distressed‟ and „to feel troubled or uneasy,‟ first recorded in the 19th century. Warriors are the persons who are engaged in or experienced in warfare. Due to the very pattern of their jobs, daily lives, serious responsibilities and assignments – most of the time – it is unavoidable to remain in worry by the warriors. The modern world, which is said to be a world of achievement, is also a world of stress. One finds stress everywhere, whether it be a family, a military station, a government set-up or any other social or economic organization. Worry or stress is an inevitable consequence of socio-economic complexity and, to some extent it‟s stimulant as well. People experience stress as they can no longer have complete control over what happens to their lives. The present-day researcher visualizes the phenomenon of stress in a new perception. Each individual needs a moderate amount of stress to be alert and capable of functioning effectively in an organization. Stress is inherent in the concept of creativity and entrepreneurship. Stress is like electricity. It can make a bulb glow and provide brilliant illumination. However, if voltage is higher than the bulb can take and the coping mechanism for higher voltage is ineffective, it results in loss of effectiveness or burnout. A burnout can be defined as the end result of stress experienced, not properly coped with, resulting in exhaustion, irritation, ineffectiveness, problems of health etc. The opposite phenomenon of glow up occurs when stress is properly channelized resulting in a feeling of challenge, job satisfaction, creativity, effectiveness and better adjustment to work and life. When individuals express stress, they try to adopt ways of dealing or coping with it as they cannot remain in a constant state of tension. They think over the stressful event and devise ways and means to adjust to such stressful events. Transformational coping involves altering the events so that they are less stressful. One has to interact with the events so that they are steered towards a less stressful direction. Regressive coping, on the other hand, includes a strategy wherein one

thinks about the events pessimistically and acts evasively to avoid contact with them. INCIDENCE IN ARMED FORCES PERSONNEL In British Armed Forces British commanders have raised concerns about the ability of the armed forces to cope with simultaneous major operations in Iraq and Afghanistan, and the UK armed forces have been asked to do more than was envisaged in the most recent defense review. Personnel who were deployed for 13 months or more in the past three years were more likely to fulfil the criteria for post-traumatic stress disorder and had multiple physical symptoms. A significant association was found between duration of deployment and severe alcohol problems. Exposure to combat partly accounted for these associations. The associations between number of deployments in the past three years and mental disorders were less consistent than those related to duration of deployment. Post-traumatic stress disorder was also associated with a mismatch between expectations about the duration of deployment and the reality. The researchers concluded that a clear and explicit policy on the duration of each deployment of armed forces personnel may reduce the risk of post-traumatic stress disorder. An association was found between deployment for more than a year in the past three years and mental health that might be explained by exposure to combat. In US Army Epidemiological studies have shown that mental disorders are associated with reduced health-related quality of life, high levels of health care utilization, and work absenteeism. However, measurement of the burden of mental disorders by using population-based methods in large working populations, such as the U.S. military, has been limited. Analysis of hospitalizations among all active-duty military personnel (16.4 million person-years) from 1990 to 1999 and ambulatory visits from 1996 to 1999 was conducted by using the Defense Medical Surveillance System. Rates of hospitalization, ambulatory visits, and attrition from military service were compared for persons with mental disorder diagnoses and those with diagnoses in 15 other ICD-9 disease categories. Mental disorders was the leading category of discharge diagnoses among men and the second leading category among women; 13% of all hospitalizations and 23% of all inpatient bed days were attributed to mental disorders. Six percent of the military population received ambulatory services for mental disorders annually in 1998 and 1999. Among a 1-year cohort of personnel, 47% of those hospitalized for the first time for a mental disorder left military service within 6 months. This

attrition rate was significantly different from the rate of only 12% after hospitalization for any of the 15 other disease categories. The difference remained significant after controlling for effects of age, gender, and duration of service. They concluded that mental disorders appear to represent the most important source of medical and occupational morbidity among active-duty U.S. military personnel. These findings provide new population-based evidence that mental disorders are common, disabling, and costly to society. PROPOSED CAUSES OF WORRY The delay or denial of expected promotion and posting, job pressure, behaviour of section commanders/peers, sickness, marital disharmony, poor performance of children at school etc could be the causes of stress. Even trifles such as telephone going out of order, power shut down and irregular water supply can give rise to stress. But then stress is necessary for human progress. It is like the strings of a musical instrument where an optimum amount of stress is necessary to produce good music. Loose wires (less stress) would not produce the notes and too much of tension (excessive stress) would lead to screening. The potential sources of stress are following: Environmental Factors: Environ-mental factors i.e. posting to a place under field conditions, tough climatic conditions etc can be stress-inducing. Technological uncertainty like induction of new armaments, equipments, machineries, techniques and inventions in military science can also cause stress because new machinery, equipment and inventions can make employees‟ skill and experience obsolete in a very short period of time. Computers, office automation and similar technological innovations could be a source of stress to many. Organisational Factors: Pressure to avoid error, completion of task in limited time, work overload, demanding and insensitive contingent commanders and unplanned workers are a few examples of organisational factors. Poor inter-personnel relationship and lack of support from colleagues can cause considerable stress especially among persons with high social need. Individual Factors: In the Armed Forces, an individual generally works for about 4448 hours a week. The problems that people encounter in other 108 non-working hours each week can spill over to the job. Individual factors generally encompass factors in the employee‟s personal life. These could be marital difficulties, family issues, economic problems, inherent personality characteristics, medical problems of relatives etc that create stress for employees when they arrive at work. Agony has an addictive phenomenon. It builds up. Each new and persistent stressor adds to an individual's stress level. A single stressor may seem relatively

unimportant in itself, but if it is added to an already high level of stress, it can be disastrous. SIGNS AND SYMPTOMS Every human being is an emotional being. The levels of emotions may be high or low. But when that level is disturbed, you have stress and anxiety. The dividing line between these two negative tendencies is very thin. Your anxiety may be due to stress or your stress may be due to anxiety. Every stress and anxiety has a root cause to it. And the symptoms are the byproducts of such causes. The first symptom of stress is that you are not a normal person, when you are seized with it. Your face will indicate what you are! People say the face is the mirror of the man. Your emotions will be disturbed and it will show up on your face. You have a feeling that is difficult to explain. You have only questions, with no definite answers. If there are answers, they are multiple answers. You see several options before you, you see several paths before you, but unable to decide which one is yours. The worry and uncertainty of the failure haunts you. You are totally confused. All these are stress symptoms. Further, with the feeling of anxiety your self-esteem is hurt and motivation is punctured. You feel that you have come to a dead end. It is a state of uneasiness that you are unable to explain with convincing reasons. You are a split personality. Your emotions are not responding to your reason. You begin to come to haphazard conclusions. Most importantly, you don't understand why you feel what you feel. The way you feel. You are facing some grim experiences and your attitude turns cynical. You feel that the human beings are ignoble. You feel that the whole world is corrupt! The symptoms may be enlisted as followings: Cognitive Symptoms Memory problems Indecisiveness Inability to concentrate Trouble thinking clearly Poor judgment Seeing only the negative Anxious or racing thoughts Constant worrying Loss of objectivity Fearful anticipation

Emotional Symptoms Moodiness Agitation Restlessness Short temper Irritability, impatience Inability to relax Feeling tense and “on edge” Feeling overwhelmed Sense of loneliness and isolation Depression or general unhappiness

Physical Symptoms Headaches or backaches

Behavioral Symptoms Eating more or less

Muscle tension and stiffness Diarrhea or constipation Nausea, dizziness Insomnia Chest pain, rapid heartbeat Weight gain or loss Skin breakouts (hives, eczema) Loss of sex drive Frequent colds

Sleeping too much or too little Isolating yourself from others Procrastination, neglecting responsibilities Using alcohol, cigarettes, or drugs to relax Nervous habits (e.g. nail biting, pacing) Teeth grinding or jaw clenching Overdoing activities (e.g. exercising, shopping) Overreacting to unexpected problems Picking fights with others

Worry is an emotionally disruptive or upsetting condition of mind which occurs in response to adverse external influences. Stress raises the level of adrenaline (a hormone & a neurotransmitter) and corticosterone (a 21 carbon steroid hormone) in the body, which leads to increase in the heart rate, respiration, and blood pressure and puts more physical stress on bodily organs. When something pleasant or unpleasant happens around you, which puts you in a state of strain or pressure, it is called stress. The consequences of stress on individuals are not same. The same set of conditions that create stress for one person may have little or no effect on another person. The effect of stress is visible in a number of ways. For example, an individual who is experiencing a high level of stress may develop high blood pressure, gastric ulcers, difficulty in making decisions, loss of appetite, accident proneness etc. Stress could create change in metabolism, increase in heart and breathing rate and blood pressure, headache and may induce heart attack. Stress can also cause job dissatisfaction and may create tension, anxiety, irritation and procrastination. It can cause changes in food habit, increased smoking, and high consumption of alcohol and sleep disorders and can lead even to suicide. The relationship between stress and job performance can be expressed as invertedU relationship. Low to moderate levels of stress stimulate the body and increase its ability to react. Under such circumstances individuals perform their task better with greater precision and rapidity. Excessive stress places unattainable demand or constraints on a person which results in lowering the level of performance. A moderate level of stress can also have a negative effect on performance over a long term as continued intensity of stress wears downs the individual and saps his energy resources. For example, performance of an individual put on guard duty continuously for long period of time may deteriorate after 2-3 days. This is the main reason for rotating guards at regular intervals.

REMEDIES What could be the root causes of symptoms of our worry and anxiety? Whenever we make compromises with our deep core values and our present disposition, our harmony is disturbed. Similarly, when we are worried about our future, future of our children due to economic or social circumstances it makes us anxious. The right attitude is to live life in its trials, tribulations, duty and beauty. Al-Mighty Allah has created us for a purpose; let‟s try our best to fulfill it, without any motivated fear! Destroy the negative feelings, before they sprout! When we manage the stress, the negative tendencies fall apart. And when this happens, relief is the natural outcome. We manage stress relief over any particular issue. Soon we are upset over another issue, which means that our mind requires further tuning. Any temporary gain is no gain at all. We don't like sending the vehicle to the garage for repairs every other day. We seek the advice of the mechanic for a permanent solution. Stress relief measures that we adopt, must chisel out a new personality of us, from our existing confusing set up. In General First of all, we have to scan your personality in an impartial manner- observe own self from a distance. Be not afraid to own our shortcomings. It is time to remove the damaged bricks in our personality and replace them with new ones! Analyze the activities of our day and begin the process of building our skills, one by one. Do not try so many things simultaneously. It is true, that the fast pace of the modern materialistic world, gives rise to various types of stress. But we cannot walk back. We have to catch up with the times. Stress relief is not in inaction, but participating in the action in an intelligent manner, by absolutely being clear about “what to do” and “what not to do” things. For that, we have to develop our time management concepts, information and leadership skills and engage ourselves in practical creativity. Let the mind go wherever it is necessary, and stop wandering aimlessly. In today's life stress strikes those who are unable to manage their time properly. Poor time management often leads to poor productivity at work place, college and schools, and lack of attention towards family. It in turn gives way to negative feed backs from those around. This negative response along with guilt of performing poorly results in stress.

Thus, proper time management is prerequisite to lead a smooth life free of stress and tensions. Productivity could be enhanced with the help of time management techniques. If we could do so, that would give us a sense of fulfillment. With this sense of accomplishment we are less likely to feel stressed. Planning in advance helps a lot in managing time. A realistic goal should be set and accordingly a feasible schedule should be prepared. One must not do a lot many things at a time, it would create confusion and outcome would be bad results. Prepare a list of works in order of priority and then proceed. In our busy corporate life, personal data assistant is very handy to practice time management. If we manage our time properly, we won't be required to take work at home which is often a cause of annoyance for family members. It would reduce family conflicts and in turn would create a stress free family environment. So, let‟s manage time and enjoy life to its fullest. An individual himself may reduce his stress level by following time management techniques, increasing physical exercise, relaxation training and expanding social support network. A well-organized individual can accomplish twice as much as compared to a poorly organized individual. Utilization of basic time management principles can help individual‟s better cope with tension created by job demands. Few of the well known time-management principles are: prioritizing activities in terms of importance and urgency, making daily list of activities and completing most demanding parts of job during alert and productive period. Physical exercise like walking, jogging, swimming and riding a bi-cycle have been recommended as a way to deal with excessive stress level. These physical exercises increase cardiac capacity, lower heart rate at rest, provide a mental diversion from work pressure and offer a means to "let off steam". Individuals can also teach themselves to reduce tension through meditation or Yoga. Talking to friends, family members or colleagues provide an outlet when stress level becomes excessive. Expanding the social network could be a means for reducing tension. In Military Life The suggested measures are: Ensuring a congenial environment in disciplined regimental life. Encouragement and nourishment of cohesion, understanding and esprit de corps. Time management in working of sections/units, so as to allow spare time to every individual. Regular off to personnel employed on shift duties. Advancement in working atmosphere/living conditions in messes.

Proper interaction within the organization and two-way communication system. More emphasis on organized games for all personnel and conduct of annual sports/athletic meets. Arrangement for unit anniversary, variety of competitive attractive educational and modest entertainment programmes. Improvement, due allocation and participation in all religious activities. Frequent visit to sainik messes, barracks and accommodations during meal times, on bar days and on occasions. Pro-active regular conduct of welfare meetings and realistic implementation of decisions. Social, religious, cultural and family affairs are to be propped up. Realistic goal setting for stations unit. System of award/honours is to be so designed that real achievers are recognized. All functional areas of a station should be given due importance. It is the role of higher formations to ensure that entitled leave is sanctioned to individuals posted to stress-prone appointments. Periodical breaks, like a two-week holiday that takes the individual away from work place and provides a homely atmosphere, can have an immense therapeutic effect. Posting profile should be planned in such a manner that an individual is not posted to such appointments regularly. In personal setting Right from the time of birth till the last day of life, an individual is invariably exposed to various stressful situations. The stress can be either a positive or negative influence on an individual‟s performance. For many people, low to moderate amount of stress enables them to perform their jobs better by increasing their work intensity, alertness and ability to react. However, a high level of stress or even a moderate amount sustained over a long period of time, eventually takes its toll and level of performance declines. Even though low to moderate levels of stress may improve the job performance individual finds stress dissatisfying. Effective management of stress involves channeling stress towards productive purposes. The topmost techniques accepted all over the world today for stress relief are meditation, exercise and massage. Each of these serves different purpose, at the same time they contribute to the total purpose of stress relief. They provide many additional advantages. Laughter is also one of the best stress relieving methods. You get ultimate stress relief, when you know the art of working for joy and not from the career view point alone. Work sincerely, by giving the maximum output, not because your boss is telling you to do it, but only because it is the correct way of life.

The following are some wonderful ways to reduce stress, anxiety and depression and promote relaxation, calm and peace within you. Some techniques take practice, and most require some commitment on your part to achieve results. However, the results are well worth an effort, as a calm and relaxed body and mind are less prone to health issues than an agitated body and mind. The 10 ways to reduce stress and stress relief are: 1) Breathing strongly influences mind, body and moods. By simply focusing your attention on your breathing, and without doing anything to change it, you move in the direction of relaxation. The causes of stress have to be found out to manage stress. 2) Progressive relaxation is a way of releasing tension in muscles, leading to stress reduction. 3) For many people, exercise is their main method of coping with stress and promoting relaxation. One of the benefits of regular aerobic exercise is its moderating effect on emotions. 4) For a wonderful, relaxing experience, get a massage or other form of body work. 5) Visualization and guided imagery are important stress management tools. Only few of us have learned how to develop our imaging capacity and take advantage of its ability to affect our minds and bodies. 6) Meditation means directed concentration. Mediators learn to focus their awareness and direct it onto an object: the breath, a phrase or word repeated silently, a memorized inspirational passage, or an image in the mind‟s eye. 7) Make a list of the top five priorities in your life now. Rank these in order of importance. When you're stressed and overwhelmed, revisit these priorities and remind yourself what's most important to you. 8) Put things in perspective. 9) Think about how important whatever is stressing you will be in a week, a month, or a year from now. Look at the big picture. 10) Simplify your life. What do you put up with or take on? What annoys you? Let go of the things you have no control over. Deal with the things you can do something about, to the best of your ability. One of the important steps to tackle the stress is to organize your environment, and budget your time. Set a time table and work according to that schedule. You

can't have more than twenty four hours in a day. Your competitors too have just that many hours. Then how they are in a more advantageous position? Think positively. Whether unnecessary thinking and stressful living, has solved any problems? Then, why worry over a matter over which you should not worry at all? Your habits have lot to do with your stress. Never postpone for tomorrow, what you can do and complete today. Tomorrow never comes. Today it will be too late. Do it just now. Remember, you can't control what happens in life. You can just face the situation. On the physical side, have a regular exercising schedule. Set a goal and continuously work on it. Take enough rest, but not to the point of laziness! CONCLUSION Worry is a complicated web. It bothers everyone, from the cradle to the grave, from the womb to the tomb. It has a combined effect, on our body and on our mind. Those who have no jobs are stressed due to unemployment. And those who have jobs! They complain about day to day job stress. There may be varied reasons, such as time spent on travelling, low salary, harassment by the boss and lots of outstation tours etc. To secure relief is the normal expectation of any individual. Nobody wishes to live continuously under stress. But it should be noted that stress is entirely different from a challenging situation. Difficulties are not to be confused with stress. Stress is mainly our inability to cope up with a particular situation or a cluster of situations. Worries vary in degree from individual to individual. So, the stress relief measures cannot be the same for all. The response for any particular situation varies. This apart, stress need not carry the connotation of sadness always. A happy event may also cause tremendous stress. Let the stress relief measures lead us to become a cheerful personality. Take it – worry is a part of life. Life is to be lived in its trials & tribulations, in its duty and beauty! REFERENCES: 1. British Medical Journal; July 2007, London, UK; 335: 603-605. 2. The American Journal of Psychiatry; September 2002, Arlington, USA;

159:1576-1583. 3. Sainik Samachar; August 2000, New Delhi, India; Vol. 47, No. 16, 16-31.