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STRESS AND SUICIDE IN INDIAN SOLDIERS

BY- DR. ROBIN VICTOR

DEPTT. OF PSYCHIATRYSMCH

2 INTRODUCTION

No human being is exempted from stress.

The army jawans are no exception.

Infact that they are comparatively in an ideal stress breeding environment due to frequent and large number of uncertainties/ changes as compared to civilian counterparts with similar service conditions.

3 What is stress?? In general terms, stress refers to

experiencing events that are perceived as endangering one’s physical or psychological well-being.

S = P > R

Stress occurs when the pressure is greater than the resource

4Statistics

There were as many as 635 cases of suicide including attempted suicides in the three services of Armed Forces during the years 2003 to 2007.

These statistics also indicate that Army was worst affected. According to Ministry of Defence, every third day a soldier is killing

himself, at a rate higher than the toll taken by the militants. From 2007 to May 2010, 208 soldiers lost their lives in actions

against militants while 368 soldiers killed themselves during this period.

5 Factors causing stress in soldiers The stress can be triggered among soldiers due to any change

or event that happens.

These factors do not cause stress in a mathematical measure.It could be a single factor or it could be a number of factors depending upon the personality traits of an individual that make him react to a stressor.

The effort here is to bring out all the factors that may initiate stress reaction in soldiers.

6 Responsiveness of Civil Administration Often it is the problem back at home that makes a soldier feel

helpless and drives him/ her to suicide than work related stress. The inability of the soldiers to solve their family problems due to

operational requirements leads to behavioural problems. According to the battalion commanders, the biggest problem is

the soldier's helplessness in resolving property disputes back at home that makes a soldier feel tense and helpless.

There are several instances of neighbours or even own brothers making use of soldier's long absence from home to encroach on his property.

7 Inter-Personal Relationship

Armed forces community has a culture of its own, where sense of belonging and responsibility are cultivated in an individual to display brotherhood.

A better interaction should be there between armed forces personnel at various levels.

The soldiers have to be encouraged to share their problems with their seniors and emphasis has to be laid to redress their genuine grievances

8 Shortage of Manpower As on March 4, 2010, there was a shortage of approximately 12,000

officers in the Army and this shortage adversely affects the 17 functioning at the unit level.

This shortage of officers is leading to greater stress among junior and middle level officers owing to the need to perform multiple functions in inadequate time.

Situation is worsened particularly in counter-insurgency operational areas, impinge upon performance of both officers and soldiers.

9 Absence of Mental Health Professionals in Units

While the strength of mental health professionals in army hospitals is lower than the required, the units in army have no mental health professionals authorized to them.

This leaves a void in the system despite increasing instances of stress among soldiers

10 Unpredictable Factors Several unpredictable factors such as: battle fatigue unseen threats extended field tenures absence of adequate recreational avenues domestic feuds inability to ensure quality education to children and inability to

meet aspirations of spouse and children increase the level of frustration, leading to stress

11 Social Apathy

A soldier believes that he is facing all sorts of difficulties to serve his nation and countrymen. The soldier has this sense of honour and duty that motivates him to face any challenges.

It is unfortunate that the society does not acknowledges their contribution most of the times.

When incidence like this happen jawan starts questioning his commitment towards his profession and the nation.

12 Remarks from seniors Most cases of fragging (killing of superiors) result from humiliating taunts by

seniors on small matters.

Due to shortages of officers, the commanding officer is unable to devote necessarily required time to his troops for counselling. The commanding officer's inability to spare time for his troops demoralises a soldier.

Junior leaders tend pass humiliating comments to their aggrieved subordinates at critical moments. This triggers emotions of revenge in the already aggressive soldier and generally results into fratricidal killings.

13 Retiring Blues The soldiers retire at a comparatively much younger age. This is the time when they are expected to share major domestic

responsibilities like higher education of children, construction of a house, marriages of children, attending to obligations towards aged parents. Starting a fresh career at this age is not an easy proposition.

14 Memories of Unfortunate incidents The combination of combat exposure and ready access to guns

can be lethal to anyone mulling suicide. Combat exposure can at times lead to trauma-such as seeing

flashbacks of combat, killings or face of a fallen comrade who might have told you about his wife or children just before quitting this world.

Memories of unintentional slayings or killing of innocent humans by mistake can also haunt them for long.

15 Reluctance in Seeking Psychiatrists Help The personnel in the armed forces are prompted to hide their mental

problems as the referral to a psychiatrist for treatment is considered a 'stigma' which may adversely affect the career of service personnel.

Since such cases have been identified to be causative factors for stress, the system of referring a soldier for psychiatrist's evaluation by the commanding officer needs a re-look.

16 Denial of Leave at the Required Time The existing leave policy is being constantly monitored to ensure that

everyone gets his due without compromising operational requirements.

The ministry of defence mentioned that the operational and functional

requirements have to be kept in view while granting leave and this aspect cannot be compromised. Here lies the catch. Under this clause, a soldier fails to get leave when he actually needs. This is a major cause of stress in army.

17 THE INDIVIDUAL

Everyone is different, with unique perceptions of, and reactions to, events.

There is no single level of stress that is optimal for all people. Some are more sensitive owing to experiences in childhood, the influence of teachers, parents and life experience etc.

Most of the stress we experience is self-generated. How we perceive life - whether an event makes us feel threatened or stimulated, encouraged or discouraged, happy or sad - depends to a large extent on how we perceive ourselves.

18 SYMPTOMS OF STRESS

Physical symptoms Mental symptoms Behavioural symptoms Emotional symptoms

19 PHYSICAL SYMPTOMS

Dizziness Fainting Sweating & trembling Tingling hands & feet Breathlessness Palpitations Missed heartbeats

Sleep pattern changes

Fatigue Digestion changes Loss of sexual drive Headaches Aches and pains Infections Indigestion

20 MENTAL SYMPTOMS

Lack of concentration Memory lapses Difficulty in making decisions Confusion Disorientation Panic attacks

21 BEHAVIOURAL SYMPTOMS

Appetite changes - too much or too little Eating disorders - anorexia, bulimia Increased intake of alcohol & other drugs Increased smoking Restlessness Fidgeting Nail biting Hypochondria

22 EMOTIONAL SYMPTOMS

Bouts of depression Impatience Fits of rage Tearfulness Deterioration of personal hygiene and appearance

23 STRESS RELATED ILLNESSESStress is not the same as ill-health, but has been related to such illnesses as;

Cardiovascular disease Immune system disease Asthma Diabetes Digestive disorders Ulcers Skin complaints - psoriasis Headaches and migraines Pre-menstrual syndrome Depression

24 Suicide Symptoms

A person contemplating suicide:- Appears depressed, sad, and tearful and/ or may display changes

in patterns of sleep and/ or appetite. Believes he/ she is in a hopeless situation. May talk about or actually threaten suicide, or may talk about

death and dying in a way that strikes the listener as odd. May display changes in behaviour, appearance or mood. May increase or start drug or alcohol use.

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May injure self or engage in risky behaviour. Abandons planning for future. May start withdrawing from others, including family and close

friends. May give away possessions. May appear apathetic, unmotivated and /or indifferent.

26 STRESS CONTROL

A = AWARENESSWhat causes you stress?

How do you react?B = BALANCE

There is a fine line between positive / negative stressHow much can you cope with before it becomes negative ?

C = CONTROLWhat can you do to help yourself combat the negative effects of stress

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27 Stress Management Techniques

CHANGE IN THINKING

CHANGE IN BEHAVIOUR

CHANGE IN LIFE STYLE

28 CHANGE IN THINKING

REFRAMING

Re-framing is a technique to change the way you look at things in order to feel better about them.

There are many ways to interpret the same situation so pick the one you like.

Re-framing does not change the external reality, but helps you view things in a different light and less stressfully.

29 POSITIVE THINKING

Forget powerlessness, dejection, despair, failure Stress leaves us vulnerable to negative suggestion so focus on

positives; Focus on your strengths Learn from the stress you are under Look for opportunities Seek out the positive - make a change

30 CHANGE YOUR BEHAVIOUR

Be assertive Get organised Ventilation Humour Diversion and distraction

31 Be AssertiveBeing assertive involves standing up for your personal rights and

expressing your thoughts, feelings and beliefs directly, honestly and spontaneously in ways that don’t infringe the rights of others.

Assertiveness helps to manage stressful situations, and will , in time, help to reduce their frequency.

Lack of assertiveness often shows low self - esteem and low self - confidence. The key to assertiveness is verbal and non - verbal communication. Extending our range of communication skills will improve our assertiveness.

32 Assertive Skills

Establish good eye contact / don’t stare Stand or sit comfortably - don’t fidget Talk in a firm, steady voice Use body language ‘I think’ / ‘I feel’ ‘What do you think?’ ‘How do you feel ?’ Concise and to the point

33 Equality and Basic Rights1) The right to express my feelings2) The right to express opinions / beliefs3) The right to say ‘Yes/No’ for yourself4) Right to change your mind5) Right to say ‘I don’t understand’6) Right to be yourself, not acting for the benefit of others 7) The right to decline responsibility for other people’s problems8) The right to make reasonable requests of others9) The right to set my own priorities10) The right to be listened to, and taken seriously

34 Assertive People

Respect themselves and others Take responsibility for actions and choices Ask openly for what they want Self - confidence remains intact Not reliant on the approval of others

35 Get Organised

Poor organisation is one of the most common causes of stress.

Structured approaches offer security against ‘out of the blue’ problems. Prioritising objectives, duties and activities makes them manageable and achievable.

Don’t overload your mind. Organisation will help avoid personal and professional chaos.

36 Time Management

Make a list What MUST be done What SHOULD be done What would you LIKE to do Cut out time wasting Learn to drop unimportant activities Say no or delegate

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Plan your day

Set achievable goals

Don’t waste time making excuses for not doing something

38 Ventilation

‘A problem shared is a problem halved’ Develop a support network through friends or colleagues to talk

with. It’s not always events that are stressful but how we perceive them.

Writing a diary or notes may help release feelings but do not re-

read what has been written.

39 Humour

Good stress - reducer Applies at home and work Relieves muscular tension Improves breathing Pumps endorphins into the bloodstream - the body’s

natural painkillers

40 Diversion and Distraction

Take time out Get away from things that bother you doesn’t solve the problem Reduce stress level Calm down Think logically

41 Change Your Lifestyle

Diet Smoking & Alcohol Exercise Sleep Leisure Relaxation

42 Diet

In general, we should include a range of nutritious foods and eat:plenty of breads and cereals (particularly wholegrain), fruit, vegetables and legumes (such as chickpeas, lentils and red kidney beans)

low-salt foods, and use salt sparingly small amounts of foods that contain added sugars reduced-fat milk and other dairy products. It is also important to drink an adequate amount of water.

43 Smoking and Alcohol

Alcohol is high in energy (kilojoules) and should be consumed in moderation.

Stop or at-least your consumption to bare minimum

Men should drink less than two standard drinks per day and women less than one standard drink per day. One standard drink is 375 ml mid-strength beer, 100 ml wine or 30 ml spirits.

44 Benefits of Exercise

Uses up excess energy released by the ‘Fight or Flight’ reaction. Improves blood circulation Lowers blood pressure Clears the mind of worrying thoughts Improves self image Makes you feel better about yourself Increases social contact

45 Sleep

The longer a soldier or a military officer goes without rest and sleep, the more his thinking slows down.

Continuous work declines speed and accuracy more rapidly than intermittent Work.

Good stress reducer Difficult to cope when tired. Wake refreshed after night’s sleep Plenty of daytime energy.

46 Benefits of Relaxation

Lowers blood pressure Combats fatigue Promotes sleep Reduces pain Eases muscle tension Decreases mental worries Increases concentration Increases productivity Increases clear thinking

47 Leisure

Interest/hobbies Games/sainik samelans/roll outs Movies Gives you a ‘break’ from stresses Provides outlet for relief Provides social contact

48 Suicide Prevention Keys The junior/ sub-unit leaders are the first ones to identify the signs of

apotential suicide-risk soldier. The following prevention keys will provide aid to persons at anticipated risk:-

Ask: “Are you thinking about hurting yourself?” Intervene immediately. Do not keep a secret concerning a person at risk.Locate help (JCO/ NCO/

doctor/ nursing assistant/ MI Room/ friend/ family/ help line). Inform your chain of command. Find someone to stay with the person. Do not leave the person alone. Expedite, get help immediately. A suicidal person needs the immediate

attention of helpers.

49 CONCLUSION

It has to be realised that every soldier and officer has to be treated as a human being with self respect and dignity

Before expecting the society and civil administration to display care for service personnel, the services themselves have to carry out introspection.

The human resource of armed forces should not be allowed to feel neglected or unwanted after vacating certain appointments.

If this aspect is sincerely addressed by the services themselves, a sharp decline in the stress and suicide levels.

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