By Maj. Richard A. Gabriel, U.S. Army Reserve

Stunned by heavy losses and breakdowns in unit morale during the 1973 war, the IDF has put psychologists in the front lines to treat battle-stress victims. Unique among Western armies, the system was successfully proved out during the recent fighting in Lebanon.

As the weapons of war become more destructive, the number of casualties that any army can expect to suffer under the stress of combat rises exponentially. Much attention has been paid by military staffs to the problems of evacuating the dead and wounded from the field of battle in order to allow the engagement to continue.

It appears, however, that few have paid serious attention to the problem of preventing and treating soldiers incapacitated and psychologically damaged by the experience of battle itself. It is difficult to discover in any major Western army any organizational unit whose mission it is to prevent and treat psychiatric battle casualties in a systematic manner.

This condition is disturbing. There is simply no doubt that as the destructiveness of modern weaponry increases the number of incidents and experiences capable of causing psychic dislocation will also increase. Further, a soldier incapacitated by fear and trauma is just as useless to a unit's ability to complete its mission as a soldier brought down by a bullet. The conditions of modern warfare make it imperative that armies learn how to prevent and treat psychiatric casualties or run the risk of having their combat power substantially reduced.

The only major military establishment in the West which has squarely faced the problem of psychiatric casualties is the Israeli Defense Force (IDF) by developing a systematic doctrine and detailed organizational structure within its combat formations for dealing with the problem. What indicators of success are available suggest that its program of preventing and treating battle stress are working remarkably well. Moreover, the creation of an integrated organizational structure for dealing with battle stress at the combat-unit level amounts to a revolution in the field of applied military psychology.

The role of the battle psychologist in contributing to the combat power of IDF units is revolutionary enough to bear close examination by other armies of the West. It is no exaggeration to suggest that the contribution of the IDF field psychologist is unique. He may well be the IDF's secret weapon in extracting maximum combat power from its limited manpower pool.

The IDF has always had an interest in battle stress, and as far back as 1948 the infant IDF even appointed a chief psychologist to conduct studies and, when the need arose, to treat trauma casualties. In retrospect, however, it appears that the program had only marginal support among top echelons and, given the relatively easy victories of 1956 and 1967, probably had little support among troop unit leaders as well. Psychiatric casualties just did not appear to be a major problem for the IDF.

All that changed with the October War of 1973. Unclassified postmortems of that war, especially in the Golan Heights, suggest that for the first time IDF forces ran a significant risk of being defeated on the battlefield. The success of the surprise attack and the large number of casualties ramified throughout the IDF and Israeli society so that-for the first time in its history-the IDF began to witness significantly large numbers of battle casualties for psychiatric reasons. While the detailed impact of psychiatric casualties on unit effectiveness has not been publicly revealed, it seems clear that in several instances it was very significant indeed.

As a consequence of the experiences of the 1973 war, the IDF set out to solve the dual problems of preventing and treating psychiatric casualties. The top leadership of the IDF recognized the importance of battle stress as a factor in unit combat capability and strongly supported the development of a program for dealing with the problem.

Responsibility for the program was given to the chief psychologist of the IDF, Col. Reuven Gal. Under his direction the IDF has made a major contribution to the world's military forms by being the first major army in the West to systematically construct and operate an on-ground, unit-based system for preventing and treating battle trauma.

The central IDF staff agency responsible for dealing with the prevention and treatment of psychiatric casualties is the Department of Behavioral Sciences of the IDF located in Tel Aviv. Commanded by Col. Gal, this unit reports directly to the chief of staff of the IDF. Given the importance of its mission, the unit is remarkably small, composed of six staff psychologists and clerical and support personnel.

The main function of the department is to draft testing instruments, provide rapid analysis of all field data, develop strategies for preventing and treating battle casualties and, most important, to co-ordinate the activities of all IDF psychological teams in the field. The staff structure and mission as outlined above is almost totally new since 1973.

Within each division of the IDF ground forces, one finds a team of psychologists. At division level this section consists of six psychologists and a small clerical support staff. Each brigade within the division has two staff psychologists assigned to it from the division section.

These teams are assigned to the IDF's basic fighting formation, the brigade, and are responsible to their unit commanders and to the central department for preventing and treating battle stress casualties.

IDF doctrine concerning psychiatric casualties stresses prevention, which is strongly supported by the high levels of unit cohesion found in IDF ground units. Nonetheless, division and brigade psychological units conduct frequent attitudinal surveys of the troops down to platoon and squad level. The Israelis have developed a number of questionnaires to gauge a unit's morale, discipline, cohesion, incidence of anticipated fear, the levels of confidence that soldiers have in themselves and their leaders and, crucially important, the expectations of the soldiers and unit commanders as to how they expect to perform under fire.

The results of these surveys are made available to unit commanders at all levels on a regular basis. They are also used as important elements in assessing a unit's or commander's abilities.

A common practice is to compare results of surveys of troops before they enter battle and again after they are removed from it. Pre- and post-activity engagement surveys are also taken before troop exercises and before small-unit missions such as reconnaissance or other incursions into enemy territory. The aim is to develop formulas for predicting unit effectiveness, as well as to locate any danger signs that might point to an incidence of stress casualties.

What is most surprising to the outsider is the high degree of confidence that unit commanders at all levels place in these surveys and predictions. Moreover, unit commanders have come to place a high degree of trust in the psychologists themselves and their recommendations. Almost universally, unit commanders seem to feel that battle psychologists are among the most important sources of information and advice available to them about the ability of their units, subcommanders and men to perform well under fire.

The organizational structure of the battle psychology units is thoroughly integrated into the normal combat structure of the IDF. The existence and function of these units are widely accepted and their ability to perform rapidly and effectively has gained them the trust of the unit commanders whom they support.

The system is so effective that a division-sized unit about to go into battle can be surveyed for key indicators of performance down to platoon level, the data sent back to Tel Aviv where the analysis is performed, and the results disseminated to concerned commanders in less than 24 hours.

The Israeli concern for preventing battle-stress casualties by the development of doctrinal theory and testing coupled with the institutionalization of teams of battle psychologists within the major fighting units truly constitutes a revolution in the field of applied military psychology. No other military force in the world has gone so far so rapidly or so systematically in its attempts to deal with the problem of psychiatric casualties.

One of the reasons why the IDF has moved so quickly in this area may be connected to the manner in which psychiatric casualties are viewed in the IDF: with the clear recognition that certain levels of stress casualties are inevitable -given the conditions of modern warfare-and with the belief that such casualties are far more the result of objective battle conditions than they are of cowardice or personality traits. Accordingly, there does not appear to be any particular stigma attached to psychiatric battle casualties.

Instead, there is the perception that such casualties result when men have been forced to endure more horror than they could reasonably be expected to withstand. There is none of the official silence in the IDF-A condition which seems to characterize other armies-that refuses to recognize the inevitability of psychiatric casualties and which implies that to establish mechanisms to deal with them in proximity to the battlefield will, paradoxically, increase the rate at which they will occur. This notion is rejected by the IDF as naive and counterproductive to effective battle units.

The success of battlefield psychologists may be due to another condition. In the IDF all officers, including battle psychologists, serve at least two years in the ranks before becoming officers and thus are well accepted as fellow soldiers by troops and officers. As with most officers in the IDF, the psychologist's claim to authority rests in having been a soldier first and a technician second.

While the IDF clearly stresses the prevention of psychiatric casualties by carefully monitoring indicators of unit cohesion, morale and confidence, battlefield psychologists are vitally important to treating those casualties that do occur. Basic doctrine for dealing with stress casualties is to treat them as rapidly and as close to the front as possible.

For the Israelis this often means administering psychiatric first aid within the battle zone and sometimes even under fire. The normal IDF mechanism for dealing with physical casualties is based around mobile armored personnel carriers (APCS) that can rapidly reach, treat or evacuate the wounded. This system also makes it possible for battle psychologists to reach, treat and reintegrate stress casualties into their units.

The Israeli incursion into Lebanon provided the first opportunity for the IDF to test its new system for dealing with stress casualties. Division and brigade psychological teams went into battle equipped with briefcases full of questionnaires designed to measure morale, confidence, stress, leadership and a whole range of other factors which contribute to unit effectiveness. As units disengaged from the front for a few hours rest, psychologists assigned to those units conducted thousands of questionnaire interviews and hundreds of group discussions right behind the lines.

As hoped, the commanders of the combat units welcomed the process because they wanted the results of the questionnaires to help them assess their units' morale, confidence and willingness to continue the fight. The troops also welcomed the opportunity to answer the questionnaires. They often wrote long responses to questions. Psychologists assessed this behavior as helping the soldiers relieve personal stress through a form of verbal and written catharsis.

The results of the questionnaires were tallied by hand in the field and given immediately to local commanders for their use. A copy of the data was sent back to Tel Aviv through a network of couriers designated specifically for this task. This data was put into computers and analyzed so that a complete psychological profile of ever-y unit in a division could be produced and disseminated within 24 hours to division and unit commanders. In short, the system of continual psychological analysis of frontline troops and units worked exactly as it had been designed.

At the same time, the battle psychologists were turned to the task of treating shock casualties. The rate of battle-shock casualties during the Lebanon incursion was only slightly less than that which the IDF suffered during the October War. However, with the new system of identification, prevention and treatment, over 80 percent of battle-shock casualties in Lebanon were treated at the front and returned to their units where they became effective soldiers once again.

Israeli psychologists note that few instances of battle shock recurred among men who had been treated as long as they stayed with their units. In a few instances, when they were removed from their unit-to be sent home on emergency leave, for example-some of them suffered a recurrence of symptoms. On balance the system worked well to prevent and treat battle-shock casualties. The rate at which men were treated and successfully returned to their units was extremely high.

The Israeli Army also developed a number of systematic and effective techniques for treating battle shock that deserve to be studied by other armies. Battle-shock cases were removed only a minimal distance from the actual fighting. In most cases, they could still hear or even see the battle.

Although they were told they were temporarily safe, they were also told they would not be moved further to the rear. The idea was to let the patient know he would return to his unit as soon as possible. Patients were not grouped together but treated as individuals.

Actual techniques of treatment included letting the soldier sleep or have an uninterrupted rest for a few hours, feeding him with good food, and outfitting him with a fresh uniform-especially if he had blood on him. Once awake, he was kept active, usually by a psychologist who walked with him while talking to him about what had happened. The soldier was pressed to recount his experiences in exact detail.

In the retelling of his story, the psychologist would support him at points of obvious stress by touching him, holding him, letting him cry, telling him he was not so different. The object was to rebuild the soldier's self-image by making him go over his story repeatedly, each time purging more and more of the fear and horror that had induced the shock.

The crucial point in the treatment, which lasted several hours, came when the soldier had to return to his unit. Instead of telling the soldier he had to return, the field psychologist would arrange for a member of his unit or several of his friends from his unit to "drop by" and ask him to come back with them because he was needed. They would then take him with them to his old unit where he would be welcomed back with a bit of fanfare. This was a clear signal to him that they held nothing against him and that he need not feel any guilt.

Using this process of treatment, over 80 percent of the battle-shock cases were salvaged and returned to their units within 24 hours with almost no recurrence of battle shock among those returned as long as they were allowed to remain with their units. By contrast, some 20 percent could not be treated at the front and were sent to special treatment centers in the rear. Interestingly, of those evacuated to the rear, none ever returned to his line unit. The contrast is striking indeed.

The IDF is the only army in the West that has a complete organizational and doctrinal mechanism for dealing with stress casualties that is thoroughly integrated into the unit command and control structure. By designing such a system, the IDF has taken a long stride toward the goal of maximizing the combat impact of its limited manpower resources. It certainly is a system that has no counterpart in any other army of the West.

Perhaps before an army can institutionalize such a system it must first rid itself of the notion that psychiatric casualties are the consequence of cowardice and personality traits. Moreover, it must rid itself of the view that to prepare to deal with such casualties actually precipitates their occurrence. The experience of the IDF is that battle stress increases rapidly as a normal consequence of modern weaponry and the conduct of war.

Accordingly, psychiatric casualties are as normal and expected a result of combat as are physical casualties. In recognizing this fact the IDF has unbound itself from some old myths which have in turn allowed it to face some new realities. And in so doing, it has been able to develop a promising response to dealing with a problem which can only grow worse as the killing power of modern weaponry impacts upon the mind of the combat soldier.

Refrence: ARMY December 1982, p. 36 - 42

MAJ. RICHARD A. GABRIEL, U.S. Army Reserve, is professor of political science at St. Anselrn's College, Manchester, N.H. He is the author of many articles and books on the military.

POSTER'S NOTE: This article by an American commenting on Israel's preparation for and prevention of Post Traumatic Stress Disorder was circulating amongst SADF psychologists in the mid to late 1980's. I had a copy with me on the border in 1987. I have generally left it in the original American spelling.