Saturday, April 9, 2022

Personality Changes Following Traumatic Combat Exposure

Ruwan M Jayatunge M.D. 

Combat trauma can cause drastic personality changes. Often these changes are negative. Nevertheless, some studies indicate that there were positive changes as well. (Positive Change Following Trauma and Adversity P. Alex Linley1 and Stephen Joseph- Department of Psychology, University of Warwick, Coventry, United Kingdom) according to the researchers' cognitive appraisal variables (threat, harm, and controllability), problem-focused, acceptance and positive reinterpretation coping, optimism, religion, cognitive processing, and positive affect were consistently associated with adversarial growth.

There are many case studies on positive posttraumatic growth that helped a person to overcome his trauma and see the world from a different perspective. Emperor Ashoka (273 - 232 BC) was one of them. In his early days, Emperor Ashoka had an undying desire to conquer. His last battle- the Kalinga War was full of human misery. He saw the death and dying of countless soldiers. He saw human suffering. After the Kalinga War, the Emperor got a new insight. He renounced war and worked for the betterment of humankind embracing Buddhism. Ashoka in human history is often referred to as the emperor of all ages.

The Spanish novelist Miguel de Cervantes (1547-1616) returned from the Crusade as a tired soldier. He fought for Spain and when he returned to Madrid after slavery, he found out that the government ignored his services and did not pay any significant attention. His mind was full of battle images and hallucinations. After coming home from long years of battle, Cervantes created the character Don Quixote filled with humor and pathos. His fictional character Don Quixote goes into dissociative episodes. He fights with windmills assuming it as enemy figures. Don Quixote’s vivid hallucinations reveal Cervantes's tired mind after long years of battle. Cervantes once said, "The truth lies in a man's dreams... perhaps in this unhappy world of ours whose madness is better than a foolish sanity."

Was Cervantes affected by combat stress? The answer could be yes.

Count Leo Tolstoy participated in the Crimean War in 1854 and fought against the French, British, and Ottoman Empire to defend Sevastapol. He was exposed to numerous war traumas that changed his personality in the later period of his life. The climax of this personality change occurred many years after the war when he was traveling to buy an estate. He had to stay in a motel and in the middle of the night, he woke up with mortal fear. This could have been a severe anxiety attack and this incident made distinct changes in him. He experienced persistent sorrow and emptiness, which he described in his autobiographical book Confession….

I cannot recall those years without horror, loathing, and heart-rending pain. I killed people in war, challenged men to duels with the purpose of killing them, and lost at cards; I squandered the fruits of the peasants' toil and then had them executed; I was a fornicator and a cheat. Lying, stealing, promiscuity of every kind, drunkenness, violence, murder - there was not a crime I did not commit...Thus I lived for ten years."

The posttraumatic growth in Leo Tolstoy helped him to become the best novelist in the World. His great epic novel War and Peace deeply analyzes the war and human psyche ranging from heroism to cynicism and from glory to emptiness.

Even after many years, some of the personality changes troubled him. In January of 1903, as he writes in his diary, Tolstoy still experienced deep unshakable sadness.

I am now suffering the torments of hell: I am calling to mind all the infamies of my former life—these reminiscences do not pass away and they poison my existence. Generally, people regret that individuality does not retain memory after death. What a happiness that it does not! What an anguish it would be if I remembered in this life all the evil, all that is painful to the conscience, committed by me in a previous life….What happiness that reminiscences disappear with death and that there only remains consciousness.

Mahatma Gandhi participated as a volunteer in the Ambulance Corps during the Boer war that fought from 1899 to 1902 between an alliance of the Boer governments and Great Britain. In the Boer war, Gandhi saw killings, torture, and horrifying atrocities. This experience affected him greatly to embrace non-violence further deep. Gandhi was against any kind of War. He refused to support the revolutionary activities of Bhagat Singh and Subhas Chandra Bose who wanted arms to struggle to free India from the British.

The Nobel Prize Lauriat Ernest Hemingway served in the Lincoln Brigade as a volunteer during the Spanish Civil War. According to the Military Psychiatrist Dr. William Pike, half of the Spanish civil war veterans suffered from severe combat-related stress. At one point, Dr. Pike was able to take 28 shell-shocked men hiding in the wine cellar. Ernest Hemingway was disgusted with the war and its horrendous nature. This new experience inspired him to write his novel Farewell to Arms. In the later years, he suffered from recurrent depression and took his own life.

Adopting Positive Stress Coping Methods

Mismanagement of combat stress can lead to misconduct stress behaviors (insubordination, desertion, social disruption, and harassment of civilians) as well as negative stress coping methods like alcohol abuse, drug abuse, domestic violence, and cruelty to children. The combatants must be taught positive stress coping methods such as seeking counseling services, meditation, engaging in recreational activities, doing sports, participating in religious work, etc. creative work like art, sculpture, and writing also helps to get away from stress.

Private PX43 served in the operational areas for over 8 years and throughout this period he witnessed death and destruction. He became restless, and agitated and gradually experienced posttraumatic symptoms. His nights were full of battle dreams and horrors that he underwent in the North. When Private PX43 was referred for psychological support services in 2004, he was treated with medication and psychotherapy. In addition, he was referred for spiritual therapy that consisted of Meditation. Within several months, his mental condition improved and Private PX43 practiced meditation with great interest. He became more positive about his life experiences and was able to overcome his posttraumatic features. By late 2006, he was free of posttraumatic symptoms.

Cpl JX54 sustained a gunshot injury to his leg and underwent below-knee amputation. His life was devastated after he became disabled. Several times, he planned to take his own life. He became hostile, blamed others for his misery, and started abusing alcohol. In 2003, he was diagnosed with adjustment disorder and treated accordingly. Gradually his stress and anxiety reduced and he was able to see his present life condition with a positive attitude. Today Cpl JX54 is free of his traumatic and self-destructive behavior and engages in an income-generating handloom business.

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