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This electronic representation of RAND intellectual property is provided for non- commercial use only. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents. This product is part of the RAND Corporation monograph series. RAND monographs present major research findings that address the challenges facing the public and private sectors. All RAND mono- graphs undergo rigorous peer review to ensure high standards for research quality and objectivity. Steeling the Mind Combat Stress Reactions and Their Implications for Urban Warfare Todd C. Helmus, Russell W. Glenn Prepared for the United States Army Approved for public release, distribution unlimited The research described in this report was sponsored by the United States Army under Contract No. DASW01-01-C-0003. Library of Congress Cataloging-in-Publication Data Helmus, Todd. Steeling the mind : combat stress reactions and their implications for urban warfare / Todd Helmus, Russell Glenn. p. cm. “MG-191.” Includes bibliographical references. ISBN 0-8330-3702-1 (pbk.) 1. War neuroses—United States. 2. Urban warfare. I. Glenn, Russell W. II. Title. RC550.H47 2005 616.85'212—dc22 2004026856 The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. R® is a registered trademark. © Copyright 2005 RAND Corporation All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means (including photocopying, recording, or information storage and retrieval) without permission in writing from RAND. Published 2005 by the RAND Corporation 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138 1200 South Hayes Street, Arlington, VA 22202-5050 201 North Craig Street, Suite 202, Pittsburgh, PA 15213-1516 RAND URL: http://www.rand.org/ To order RAND documents or to obtain additional information, contact Distribution Services: Telephone: (310) 451-7002; Fax: (310) 451-6915; Email: [email protected] Preface Combat stress casualties can severely limit the manpower required to conduct military operations. This manpower loss may be even more accentuated during urban combat operations. Commanders and NCOs in the U.S. military should develop the necessary skills to treat and prevent stress casualties and understand their implications for urban operations. To impart this knowledge, this monograph reviews the known precipitants of combat stress reaction (CSR), its battlefield treatment, and the preventive steps commanders can take to limit its extent and severity. In addition, this monograph reviews the stress casualty evidence of prior urban battles in order to enhance under- standing of the risks of urban operations with respect to the develop- ment of CSR. Both treatment and prevention are also examined from an urban operations perspective. This study will be of interest to military commanders and senior NCOs. The actions of these individuals have the greatest impact on the occurrence of battle fatigue and its proper treatment. This mono- graph was written with this audience in mind. Military and civilian medical practitioners and scientists will also take interest, especially with regard to the review of stress casualty rates in prior urban opera- tions. This research was undertaken for the Training and Doctrine Command of the U.S. Army and was conducted in RAND Arroyo Center’s Force Development and Technology Program. RAND Ar- royo Center, part of the RAND Corporation, is a federally funded iii iv Steeling the Mind research and development center sponsored by the United States Army. For more information on RAND Arroyo Center, contact the Director of Operations (telephone 310-393-0411, extension 6419; FAX 310-451-6952; email [email protected]), or visit Ar- royo’s web site at http://www.rand.org/ard/. Contents Preface....................................................................... iii Figures ...................................................................... ix Tables ....................................................................... xi Summary................................................................... xiii Acknowledgments.......................................................... xxi Acronyms .................................................................xxiii CHAPTER ONE Introduction .................................................................1 The Urban Dilemma ........................................................5 CHAPTER TWO A Look Back: A Brief History of Combat Psychiatry ......................9 U.S. Civil War and Before ...................................................9 The Great War............................................................. 10 World War II .............................................................. 13 Post–World War II ........................................................ 16 Korea.................................................................... 16 Vietnam ................................................................. 17 The Israeli Wars......................................................... 20 Developments and Experiences Since 1983 ............................ 21 CHAPTER THREE The Lessons of War: The Causations of Battle Fatigue .................. 23 Individual Factors.......................................................... 23 v vi Steeling the Mind Personality .............................................................. 24 Nonmilitary Stressors ................................................... 24 Education ............................................................... 25 Unit Factors................................................................ 26 Morale .................................................................. 26 Self-Confidence ......................................................... 27 Faith in Command ..................................................... 27 Cohesion ................................................................ 27 Combat Assignment .................................................... 28 Battlefield Contributors to Stress .......................................... 31 Anticipation............................................................. 31 Combat Intensity ....................................................... 32 Duration ................................................................ 33 Type of Battle ........................................................... 34 Physical Hardships ...................................................... 36 Summary................................................................... 37 CHAPTER FOUR Stress in the City: An Evaluation of the Risk of Combat Stress Reactions in Urban Warfare ..................................................... 39 A View from the Ground .................................................. 41 The Impact on Combat Stress Reaction ................................... 43 A Look at the Numbers.................................................... 45 World War II .............................................................. 45 The Battle for Brest ..................................................... 45 Battle of Manila......................................................... 49 The Battle of Hue....................................................... 51 More Limited-Duration Urban Conflicts ................................. 55 Panama.................................................................. 55 Task Force Ranger ...................................................... 57 Battle of Jenin, Israel.................................................... 58 A Secondary Analysis ...................................................... 59 Summary................................................................... 62 Limitations of the Review............................................... 62 Hypothesized Protective Factors for Urban Combat Operations ...... 63 Application Toward Future Urban Conflicts May Be Limited......... 65 Contents vii CHAPTER FIVE Reversing the Tide: Treatment Principles for Battle Fatigue ............ 69 Symptoms and Diagnosis .................................................. 69 Treatment.................................................................. 72 Doctrinal Echelons of Treatment....................................... 72 Treatment by Mental Health Units ....................................... 73 The Role of Expectation ...............................................