Saturday, January 6, 2007

Fighting stress

Last year saw about 130 suicides in the Army. Admitting that the deaths are related to stress, the Army now plans to recruit 400 psychiatrists besides adopting other stress-busting measures.
Vijay Mohan reports

The Army claims that most cases of suicide occurred after the soldiers returned from leave
The Army claims that most cases of suicide occurred after the soldiers returned from leave

On December 1, a lieutenant colonel posted on a staff appointment in one of the counter insurgency formation headquarters was found dead in his room. Reports suggested that he had committed suicide.

Whatever be the reason behind his death, the officer — with 14 years of service behind him — became another statistic in the long list of armed forces personnel who have either been killed by colleagues or taken the extreme step of committing suicide while serving in the high-risk, stress-prone low intensity conflict (LIC) environment in Jammu and Kashmir as well as the North-East. Just about a month ago, a lieutenant colonel was shot by a jawan who had been reprimanded.

As many as 450 soldiers died in the past 42 months. Out of them, 355 are stated to have committed suicide. To tackle such distress deaths in its ranks, the Army now plans to recruit 400 psychiatrists. "We have sent a proposal for recruiting 400 psychiatrists of officer rank so that senior officers can also approach them," said Director-General of the Armed Forces Medical Service V.K. Singh during his visit to Chandigarh last month.

"The most important factor for stress is the family left behind by soldiers posted in remote areas," he said. "Unlike as in some western countries, the Indian soldier is emotionally very attached to his family. Leaving them behind under changing socio-economic conditions, with an unresponsive civilian administration and no joint family to look after their needs, leaves him insecure," he added.

Distress toll

Figures released by the Ministry of Defence disclose that from January 1, 2006, to November 14, 2006, the number of suicides in the Armed Forces was 128, which include five officers, five junior commissioned officers and 118 personnel from other ranks. Col Pankaj Jha was the sixth officer to take his own life this year. The number of suicides reported in 2004 and 2005 were 116 and 119, respectively.

The suicides are attributed to stress and psychological disorders, which in turn reportedly come with personal and family problems like marital discord, medical problems, depression and property issues as well as organisational factors. Also to be blamed in come cases is poor man-management and commanders’ preoccupation with operational matters at the cost of administrative issues.

Statements issued by the Army and the Ministry of Defence say that most of the cases of suicide and fratricidal killings have occurred within a few days of the soldiers concerned returning on duty after leave.

A recent study, Evolving Medical Strategies for Low Intensity Conflicts – A Necessity, conducted by four Army doctors, Brig Jasdeep Singh, Col H. K. Sharma, Lt Col Jaiprakash and Lt Col Ajay Dheer, listed six conflicts which go on in a soldier’s mind. These are:

  • The inability to resolve the contradictions between general war and the LIC, particularly the concepts of ‘enemy’, ‘objective’ and ‘minimum force’. Moreover, there are no clear-cut victories like in wars. This is not a war against an enemy, therefore casualties are difficult to accept. As casualties occur over a protracted period, their impact is greater.

  • The special ideological values that a soldier is brought up on are often at cross-purposes with those of an unconventional battlefield. In general war the nation looks upon the soldier as a saviour, whereas out here he is at the receiving end of public hostility. Unable to understand these conflicting reactions, the soldier is desensitised.

  • Hostile vernacular Press keeps badgering the security forces, projecting them as perpetrators of oppression.

  • Continuous operations affect rest, sleep and body clocks, leading to mental and physical exhaustion. Monotony, the lure of the number-game and low manning strength of units lead to over-use and fast burn-out.

  • The threshold level of absorbing own casualties varies from unit to unit, depending upon the background of the troops. Paradoxically, the pressure on troops is always to suffer less casualties and achieve more. The dichotomy the soldier faces is straight –"We want results but we do not want casualties".

  • The high frustration level is because of :

Ambiguity regarding success i.e. are we moving forward or standing still? Lack of kills and recoveries for a long time.

Apprehension regarding over-reaction that could result in human rights violation.

The researchers also noted that the improvement in general educational standards, technological advancements, especially in communication and media, social changes, breakdown of the joint family system, materialism, scant regard for law and order, more and more people from urban areas joining the forces, changed moralities and value systems and so on have a bearing on the requirements and aspirations of today’s soldier.

Emotional support

Observing that the LIC has a history of over five decades in India and LIC operations are not a passing phase in human history but a mode of warfare which has come to stay, the paper stated that it would be prudent to plan for an emotional support team, which could identify stress disorders and provide first-aid at
the earliest.

Psychological disorders, said the report, should be tackled with emotional first aid, for which every section and platoon commander must be trained. The study recommended a training capsule under an experienced psychiatrist for medical officers, who could be posted to units operating in high-risk areas. The nursing assistant and combat commanders at the section, platoon, company and battalion levels could be trained by the medical officer through sessions at the battalion level.

Further, at the brigade level for those operating in the Valley and other insurgent areas, ideally an emotional support team manned by a team comprising a psychiatrist, a psychologist and a psychiatrist nursing assistant could be placed or else a mobile emotional support team should visit such formations periodically and stay for a sufficient duration so as to train, identify and treat. These teams can provide immense psychological support to battalions, which have suffered casualties in an operation.

The researchers felt it would be a good idea to distribute to soldiers laminated cards, listing indicators for stress and emotional disorders along with emotional first-aid procedures. The paper cautioned that if symptoms were ignored for too long a period, the casualty would need specialist psychiatric care.

Treatment of psychological problems in armed forces personnel has also been raised by Parliament’s Standing Committee on Defence, which in a report tabled this year noted with "concern" that there was a substantial increase in the stress environment, which led to psychological problems.

According to the available data, 2,709 personnel were admitted to psychiatric centres in military hospitals in 2000. This figure rose to 4,982 in 2004. The number of psychiatric patients boarded out of the service, however, came down from about 17 per cent in 2000 to about nine per cent in 2004.

The committee recommended to the Ministry of Defence to seriously examine the issue and post doctor counsellors, specialising in this subject, particularly in field units. The committee also desired that there should be a study of reasons that lead to stress and this feedback should be used by doctors to treat patients.

The ministry, on its part, has stated that the incidence of suicides or cross-shooting (fragging) hasn’t increased. It says several measures have been adopted to check stress levels among troops, who are being personally monitored by senior commanders.

The measures include increased formal and informal interaction between senior and junior officers; strengthening the time-tested reporting and feedback system in the unit; using services of psychiatrists and counsellors to conduct lectures and presentations and educate personnel; identifying personnel under stress; and carrying out psychological conditioning and counselling.

Training capsules in relaxation exercises like yoga and meditation; rotation of units and individuals to minimise exposure to stress and posting Army Medical Corps Junior Commissioned Officers as psychological counsellors to interact with the troops and alleviate their stress-related problems are among the other new measures. Two psychiatric centres in the Northern and Eastern Commands have been augmented by posting additional psychiatrists.

Inquiry lapses

The ministry maintained that all cases were investigated through a court of inquiry (CoI) to ascertain the cause of death. However, in the recent past, there have been several instances where family members of the deceased have questioned the fairness and authenticity of such inquiries.

Col S.K. Aggarwal, who retired from the Judge Advocate-General’s (JAG) Department, the Army’s legal wing, and has dealt with several such cases, believes that the Army does not believe in transparency and sharing information with others lest their lapses embarrass and expose the authorities concerned.

"Instead of investigating death cases with an open mind, a concerted effort is made to suppress the truth at the stage of CoI itself. Due to biased investigations conducted with a pre-mind set, the real causes remain hidden, because of which one loses confidence in the impartiality of the CoI and JAG," Colonel Aggarwal said. "Death of a soldier is not a ‘cause’ but ‘effect’ of some causes and unless causes are found out through honest and sincere investigations, effect will continue to recur and society will continue to pay a heavy price," he added.

The real reasons for an increase in death cases are poor man management; old mindset; not granting leave on time; lack of rest and sleep; discourteous, inhuman and injudicious conduct of senior officers towards subordinates; discriminatory and partisan role of COs, high-handedness, deteriorating military judicial system, promotion of incompetent officers, rise in educational and socio-economic standard of jawans and lack of proper training, he said.

It was but natural that in an inhospitable environment, one tends to get irritated and angry over small issues. In such inhuman conditions, one may not commit suicide but use criminal force against a superior. Hence, instead of taking shelter behind excuses, commanders should address the problem seriously, he remarked.


All command and zonal military hospitals have psychiatric treatment. Psychiatric centres are located in hospitals in areas of counter insurgency (CI) operations like 92 Base Hospital, Srinagar; 155 Base Hospital, Tejpur; and 151 Base Hospital, Guwahati. They focus on treatment at primary and secondary levels.

Primary prevention

Stress management lectures given by Regimental Medical Officers (RMOs) in the field.
Officers, non-commissioned officers and religious teachers are trained as resource persons in separate batches at psychiatric centres. They are given capsule course of one week to identify and manage stress in the field.
Psychiatrists in base hospitals conduct lectures on stress management on induction of troops for the first time in CI operations.
Once the personnel are identified to be suffering from stress-related psychological disorders, they are removed from the workplace and admitted to psychiatric centres for observation and management.

Secondary level

Poor man management is said to be one of the causes of stress
Poor man management is said to be one of the causes of stress

After proper evaluation and diagnosis, psychiatrists attend to patients with:

Modern drug therapies
Psychological form of therapy like psychotherapy sessions, relaxation techniques, behavioural therapy and religious therapy.
Sick leave to facilitate
Re-evaluation and return to unit under sheltered appointment.
Only those patients who do not recover after sufficient length of observation in sheltered appointments are discharged from service.
More serious psychiatric illness like insanity are offered the best available treatment with modern drugs and put under sheltered employment. They are retained in service as long as possible but discharged only when sheltered employment cannot be provided or relapses are so frequent that they become a liability to service.