Military Employee Stress
The objective of this work is to compare, contrast and synthesize and evaluate the principles of societal development including an evaluation of the workplace and resulting family stress. In order to understand the effects of how societal development in the workplace has affected the family unit, an evaluation of the workplace and resulting family stress will be conducted. Additionally, this work will compare, contrast and evaluate the work of Weber, Durkheim, Spencer and Marx, the four social theorists upon whose work this study will be based and upon which the integration of current information meaning included in scholarly journals written by experts on family dynamics will be applied to the findings from actual application.
BREADTH OBJECTIVES
The objectives of the 'Breadth' portion of this study is the investigation of the social forces in society that direct changes with the individual, group and organizational levels. More specifically this study will draw from the opinions of the theorists to help look at how the work place environment affects the employee, his or her family, and the community. Important learning objectives for the Breadth component are to compare and contrast current and past theories of societal development of Marx (1818-1883), Durkheim (1858-1916), Weber (1864-1920), and Spencer (1820-1920).
B. DEPTH OBJECTIVES
Information gathered from articles that offer current research about societal change will reveal useful ideas that will lead to positive continual change. Research findings will help organizations learn to develop more effective employee programs that will in turn affect families positively at home. Positive relations at home will influence communities by the same outflow process. An example of an outflow process would be to influence individuals that the family members come in contact with in a manner in which, whether positive or negative results maybe influential. In some cases if the family is experiencing a dysfunctional family system, this negative influence may or may not flow outwardly from the home, into the community. The primary learning objectives for the Depth component are to: (1) Analyze, compare, and contrast current point-of-views on the organizational cause and effect of social change; and (2) Make a tentative discernment of the ideas by evaluation to improve the quality of employee management
C. APPLICATION OBJECTIVES
The concluding part of the KAM will employ the opinions of original theorists with respect to societal development. Data collected from the peer-reviewed resources will conjoin with the Depth and Breadth components. Information examined from leading theorists and current information, from peer-reviewed sources will be analyzed in order, to execute the application findings from military employees. Learning objectives for the application: (1) gather data for comparison and contrast with past and current research theories to determine possible solutions to work-related stressors that, affect employees and their families and extended communities; (2) Analyze data collected by survey and observation to add to archived information that will solve work-related stressors that affect employees, their families and extended communities; and (3) Evaluate measurement or statistics to produce useful effects for the societal development framework within institutions and learn about its change throughout history. Use the results to find solutions to employee problems in the institution observed.
SIGNIFICANCE of the STUDY
The significance of this study is the knowledge that will be added to the already existing knowledge base in this area of study through discovering information related to work place stress and its effects on the family unit and community and through comparison of known theories that relate to work place stress and through evaluation of how this trend could affect the family balance through observing the older and more culturally and ethnically diverse female employees and their niche in the workforce including the military schedule and its effect on this working population and finally through analysis of the quality of lifestyle of the military families that live in government housing and the difference in family quality of those who live in civilian housing and how this is affected by military life.
STUDY DESIGN
. Children and spouses left alone will need to draw on the community for support along with military family programs. Applying theory, current research and observation of these families affected by the military work schedule will provide positive information to the data banks. Along with the data gathered about work place stress, additional current knowledge about work stress researched will specify problematic evidence from collected information. This information will reveal important findings that connect the work place with the domestic life. A comparison of the transitory effect of working and returning home each day, week, or month will become clearer. The Breath component brings together the studies of the four listed theorists, which have had an impact on past and current societal development. The theories discussed will ground the foundation for the research and development of the depth section. The Depth section compares and contrasts current research about work stress and the impact it plays on the family and community. Current research information will be analyzed, and evaluated, how work and home life are affected by factors that contribute problematic transitions. The Application area will apply understanding and knowledge to the hands-on execution of collecting information to add to the current database of information to help change society. This will also help provide other effective ways of managing, workplace stress. The information obtained and assimilated into the knowledge bank will generate a more positive environment for military families and the community.
INTRODUCTION
Today's military is increasing diverse placing greater demands on mental health care services and assistance to military members and their families. The work of Johnson et al. (2007) notes that the demographics of the U.S. military have undergone significant changes in that that U.S. military has "made great strides in increasing diversity throughout its ranks. Today there are approximately three million Americans serving their country in uniform, representing the Navy, Air Force, Coast Guard, Marines, Reserves and National Guard. Over one-fourth of those serving on active duty today are members of an ethnic minority. Approximately a quarter of a million of our active duty troops, reservists, and National Guard members are either preparing to deploy or are deployed, and three out of every five of these deployed service members have family responsibilities (i.e. spouse and/or children). In addition, women now make up 16% of this all voluntary military force and are assigned to 90% of all military job categories." (Johnson et al., 2007) in previous years Johnson et al. (2007) relates that approximately 450 active duly licensed clinical psychologists served the U.S. In uniform however, presently this number is less than 350, which is a 22% decrease "and the rate of attrition continues at an alarming pace." (Johnson, et al., 2007)
Research is limited in this area and few studies exist however, one of these studies is that conducted and reported by Charles Hoge, MD and colleagues, Walter Reed Army Medical Center and the Uniformed Services University of the Health Sciences reporting three "seminal studies" which are as follows:
(1) Hoge, Castro, Messer, McGurk, Cotting, and Koffman (2004) -- this study was published in the New England Journal of Medicine and had as its focus members of four combat infantry units in which anonymous surveys were administered before being deployed to Iraq (2,530) and three to four months after returning from Iraq or Afghanistan (3,671). Johnson et al. (2007) state: "Command leaders held meetings at which the researchers solicited participation; methods used to ensure anonymity were explained to potential subjects. In all, 58% of the soldiers and Marines from the designated units attended the recruitment meetings. Among those who attended the meeting, 98% participated in the study. Mental health functioning was assessed using standardized screening questions targeting diagnostic criteria for major depression, generalized anxiety (Patient Health Questionnaire, Spitzer, et al., 1999), and PTSD (National Center for PTSD Checklist, Weathers et al., 1993). In addition, subjects were asked about their level of stress and emotional problems, use of alcohol, family problems, interest in receiving mental health care, past use of mental health care, and perceptions about barriers to accessing mental health care." (Johnson, et al., 2007)
(2) Hoge, Auchterlonie & Milliken (2006) -- This study was published in the Journal of the American Medical Association in March 2006 as is stated to have been a "descriptive study of all Army Soldiers and Marines "…who had completed a Post-Deployment Health Assessment (PDHA) from May 1, 2003 until April 30, 2004. In all, 303,905 subjects completed the survey after returning from deployment during this time, including 16,318 from Afghanistan, 222,620 from Iraq and 64,967 from other locations. All subjects were followed up via the Defense Medical Surveillance System (DMSS) database for one year after deployment. The DMSS is an integrated public health database that includes demographics, information about military careers (e.g., rank, occupation, dates of entry and separation, and deployment history), and data on health care visits within the Military Health System." (Johnson, et al., 2007)
(3) Grieger, Cozza, Ursano, Hoge, Martinez, Engel, & Wain (2006) -- This study was published in the American Journal of Psychiatry in October (2006) and was a descriptive study that analyzed the "rates, predictors, and course of posttraumatic stress disorder and depression among seriously injured soldiers. The subjects were 613 injured Army personnel Military Deployment Services TF Report 13 admitted to Walter Reed Army Medical Center from March 2003 to September 2004 who were capable of completing the screening battery. Soldiers were assessed at approximately one month after injury and were reassessed at four and seven months either by telephone interview or upon return to the hospital for outpatient treatment. Two hundred and forty-three soldiers completed all three assessments. Posttraumatic stress disorder was assessed with the PTSD Checklist; depression was assessed with the Patient Health Questionnaire. Combat exposure, deployment length, and severity of physical problems were also assessed." (Johnson, et al., 2007)
I. BREADTH (SOCIAL THEORISTS)
A. KARL MARX (1818-1883)
Karl Marx was born into a Jewish family that had converted to Christianity and is held to be the "world's greatest theorist of capitalism and materialism." (Lukas, nd) Marx earned his Ph.D. In law and philosophy. Marx has been considered both a genius and a madman and there are many misinterpretations of what Marx was expressing and actually represented. Marx focused on explaining how future social systems are shaped by past events and ultimately rejected Hegelian philosophy stating: "Die Philosophen haben die Welt nur verschieden interpretiert, es kommt aber darauf an sie zu veraendern," which translated means "The philosophers have only interpreted the world in various ways, the point, however, is to change it." This is directly in contrast to the work of Herbert Spencer who expressly wanted nothing to do with changing society. In the attempt to understand Marx it is first necessary to "acknowledge his ontological position -- that of materialism." (Lukas, nd)
Materialism is a view that places emphasis on the "real, objective, material conditions of the world as they are founded in economic, political and technological structures, as the determining factors behind our social structure and out individual actions." (Lukas, nd) Marx holds that whether the individual is aware of it or not that material conditions hold power over the individual and dominate the individual. Marx focuses on the 'means of product' which includes the technology, energy and resources of capitalism in combination with the 'relations of production' which includes managers, employees and investors, as being the two primary capitalist system components. Marx additionally uses the term 'base' to refer to the "economic foundation of the society and superstructure which refers to the valuative social institutions of religion, polity, education and the like." (Lukas, nd) These two sectors are held by Marx to be closely linked in that the base determines superstructure and these terms are representative of the game rules inherent in capitalism. Players in the game of capitalism include:
(1) Proletariat -- those who are paid less than the value of their work;
(2) Capitalists/Bourgeoisie -- those who have the power in controlling access to the means of production;
(3) Lumpen proletariat -- those who are under- or unemployed and work only where they are needed by the capitalists/bourgeoisie and those who occupy the bottom run of the social ladder.
From the view of Marx these players are in a game that is the philosophy of materialist thought is a fixed game. The game is fixed through means of profits and in capitalism profit making is the primary goal. The primary factor in capitalism's success is that of labor and further important is that of 'surplus value' or the "extra value that comes from the blood, sweat and tears of the worker. This value includes the stored-up energies of workers as they sleep at night and the hours that they put in at work -- for which they are not fully compensated." (Lukas, nd) Added to this the bourgeois legality has been devised by capitalists which is a "legal system that protects the capitalist system." (Lukas, nd) Lukas states that while this legal system "…will assure that no excesses come to harm workers, its ultimate function is to allow the game of capitalism to be fixed at the legal level." (nd)
It is held that the primary 'fix' utilized in the capitalist game is that of the use of 'ideology' which is a "…direct result of the mode of production in a society." (Lukas, nd) Ideology can be defined as "justifications for existing social relations." (Lukas, nd) Ideology is used to hide the truth in reality so that the control of the means of production can be maintained by the capitalists within the society. Marx and Engels stated in relation to ideology as follows:
"If in all ideology men and their circumstances appear upside down as in a camera obscura, this phenomenon arises just as much from their historical life-process as the inversion of objects on the retina does from their physical life-process…the phantoms formed in the human brain are also, necessarily, sublimates of their material life-process, which is empirically verifiable and bound to material premises." (Marx and Engels 1947:14).
Marx's philosophy of capitalism states the results are quite simple in that the winners are the capitalists and all others are the lowers. In the end the workers are experiencing what Marx calls 'alienation' or the "disconnection of estrangement between the worker and the process of production and the product itself." (Lukas, nd) it is this conflict perspective that relates to the organization within society and specifically refers to those holding the power and those devoid of any power when viewed through ideological and economic lens.
B. EMILE DURKHEIM (1858-1917)
Emile Durkheim was one of the most influential sociologists and like other thinkers of influence Durkheim was in search of understanding of the society that was in constant change and constantly characterized by contradictions. Durkheim's father was a Jewish Rabbi. Durkheim "…became immersed in the intellectual world of society and ideas as a student at the Ecole Normale SupErieure in Paris. Durkheim's interaction with others in his life world came to influence his curiosity about the world and his desire to interpret it." (Lukas, nd) This search for understanding is illustrated clearly in Durkheim's study of religion and social integration in his work 'Suicide' (1966) in which he sought to understand why a close friend of his had committed suicide. Durkheim held that suicide is an inherent "social consequence of the world and its organization" emphasized that "suicide rates were inversely proportional to the level of social integration endemic to religions -- in the case of Protestantism, suicide rates were higher, while Catholics and Jews had lower suicide rates." (Lukas, nd)
It was the argument of Durkheim that due to the stressing of independence in Protestantism and the fact that its members are less integrated in society that an increased possibility of suicide existed among Protestant members. Durkheim held that rather than going through abstractions and generalizations about the world that "sociology should develop concrete forms of social analysis." (Lukas, nd) Durkheim, just as did Comte, held concerns and felt a need to understand the relationships within society in what is termed a 'functionalist' approach. Durkheim stood as an advocate of robust social theory development through empirical studies and rigorous methodology and his conceptualization of 'social facts' is one of his primary contributions to advancing empirical sociology. It was Durkheim's position that "social facts existed independently of the individual…" (Lukas, nd) However, those social facts nevertheless impact the individual. In fact, it is this belief of Durkheim that best illustrates the perspective of realism held by Durkheim which is a perspective that places the emphasis on "the existence of a social reality independent of human understanding of it, the world forms a basis of social relations and social organization which must be understood by the sociologist in order to comprehend the nature of social reality." (Lukas, nd)
Durkheim additionally advocated what was a comparative approach to sociology "comparative sociology is not a particular branch of sociology, it is sociology itself." (Durkheim 1938: 139) the comparative approach places emphasis on the meaning of one part of society, or one whole society and that there is only understanding of this in the part (or society) in its relationship to other parts or other societies. Lukas states of Durkheim that he was "…fascinated with the freeing of industrialization from the social and moral orders and how the fundamental problem of normative disruption is tied to processes of industrialization." (nd) the dissertation of Durkheim evolved into the famously named 'The Division of Labor in Society' written in 1933 in which a comparative understanding of the social order was established. Durkheim is considered to be one of the first public sociologists in history due to his "willingness to spark controversy in the discipline -- a fact established by the edginess of his 'The Rules of the Sociological Method'. (Lukas, nd) Durkheim believed that "moral consensus was a necessary foundation for social solidarity…" (Lukas, nd)
Durkheim placed an emphasis on the belief that progress could result in society however, he did not hold, as did Marx that "the state was the site of class domination, he instead felt that the state itself could be reformed." (Lukas, nd) Durkheim was an optimist and this is demonstrated in Durkheim's concept of moral reconstruction and just as did Marx and Weber, Durkheim understood "the impact of the coming of industrial society on the individual and the specific social bond that he believed each individual needed in order to psychologically relate to society." (Lukas, nd) the identification of certain types of solidarity characteristics in different societal eras was made by Durkheim as: (1) mechanical; and (2) organic solidarity. Durkheim states that a pathological society was one in which the norms was either not strong enough or alternatively too strong making a society prone to 'anomie' which is a "breakdown in the ability of society to regulate the natural appetites of individuals" (Vold and Bernard, 1986: 185)
It was the suggestion of Durkheim that as society becomes more dominated by forces of an impersonal nature that these two forces enables society to push toward moral reconstruction in the forms of occupational association and education. It was Durkheim's belief that eventually "sociology could cure society." (Lukas, nd) Durkheim further contributed to functionalism in his belief of the "normality of crime" in which he suggested that "contrary to poplar opinion, crime is a natural, desirable and even progressive force in society. He offered that crime fulfilled a specific function in society, and in the ways that it creates solidarity among people, marks boundaries between groups, reminds people of their social values, offers tension-reducing functions for society, and eventually produces social change and innovation in society, crime can be said to be necessary and positive for a given society." (Lukas, nd)
Durkheim emphasized the need of all individuals in suspending their own moral opinions relating to social issues. The division of labor is a term utilized in social theory in reference to the "process of dividing up labor among individuals in a group so that the main economic and domestic tasks are performed by different people for the purposes of the collective maintenance of society. The process of the division of labor therefore begins as soon as individuals form themselves into groups where, instead of living isolated or alone they cooperate collectively by dividing their labor and by coordinating their economic and domestic activities for purposes of survival." (Morrison, 2006) it was held by Durkheim that the division of labor "was therefore the result of a social process taking place within the structure of society rather than the result of the private choices of individuals or the result of organic traits that emerged during evolution." (Morrison, 2006)
C. HERBERT SPENCER (1820-1903)
Herbert Spencer was a social theorist in Britain in the nineteenth century and just as Comte, Spencer's "…legacy to the discipline of sociology is the subject of much academic debate." (Lukas, nd) Spencer grew up in "a tradition of nonconformity. His education, much like his early life, was nontraditional." (Lukas, nd) Spencer's first employment was in the capacity of a railroad engineer at seventeen years of age and it is believed that his extensive mechanical knowledge affected philosophy of society and evolution. The first systemic description of analysis through means of sociology was found in 'The Principles of Sociology (1877) written by Spencer. Social control is referred to by Spencer as a "system of restraints." The assumption of Spencer concerning society as he conceived it within the concept of 'organicism was that society was 'superorganic' organized much as the body's biological organization and viewed it as a mechanistic system rather than adhering to the belief of natural selection as the primary process contained in the conception of evolution. In fact, the comparison made by Spencer between the system of biology and of society were quite controversial at the time he posited these beliefs. Spencer's beliefs regarding evolution and its being a natural law in terms of the physical, biological and even social universe (Perdue 1986: 59) and this view has been deemed to be 'deterministic' (a perspective state that states that one primary factor or force is the explanation for the nature of reality; in Lukas, nd)
Spencer was in actuality "a social Darwinist before Darwin, and he coined the phrase 'survival of the fittest' -- a concept that remains his most controversial legacy to sociology." (Lukas, nd) Spencer has been called "the first structural-functionalist…he theorized that society could be best understood through social statics and social dynamics, but what is more pronounced in Spencer's "social organism" is an emphasis on self-regulation and equilibrium. In terms of social institutions, Spencer defined them as either sustaining, such as kinship and marriage, distributing, like economics, and regulating, like religion and polity." (Lukas, nd) This is the same as stating that a "…regulating institution like polity is analogous to the regulating system of an organism like the nervous system." (Lukas, nd) Spencer held that social systems were actually "…were maintained in the equilibrium of these institutions and through processes of what he called "reciprocal influences," such as how sexual norms impact the family (cf. Inkeles 1964:5)." (Lukas, nd) Spencer held that the state should not involve itself in the business of citizens which is a proto-libertarian stance and among his beliefs the following are stated by Spencer:
(1) a belief that hierarchy was a natural state of society;
(2) Posited the principle of dissolution which held that unfit societies will eventually disappear; (3) took a stance against public education because of the need to allow the children of superiors to outlast the children of inferiors;
(4) Held the view that nations that were less advanced could serve to halt the progress in evolution of other nations that were geographically adjoined with them;
(5) Believed that the state should only serve the individual, with no measures of egalitarianism or public good -- what one sociologist calls "antisociety" (Perdue 1986:62);
(6) Held various positions against public works projects, including public education, a nationalized postal system and aid to the needy;
(7) Held fluctuating views on the rights of women and children. (Lukas, nd)
D. MAX WEBER (1864-1920)
Max Weber is described as a "holistic sociologist" who "sought to make meaningful all of the realms of everyday life -- economics, authority and politics, legal history, urbanism and the city, religion, music and social class." (Lukas, nd) the focus of Weber was "individual subjectivity." (Lukas, nd) Weber's life was one that was "full of moments of eccentricity, tragedy and varying levels of political participation in Germany." (Lukas, nd) His mother was a strict Calvinist and it is believed that these religious values impacted his work "The Protestant Ethic and the Spirit of Capitalism" (1930). Weber passed the law examination in 1884. The beliefs of Weber greatly contrasted with those within his home country of Germany in terms of the political order of that time. Weber stated the problem of state power during the reign of Bismarck, which was characterized by expansion of government bureaucracy that reached even into the university system as industrialization grew and resulted in division of the force of labor in the country of Germany. Weber assisted in writing the new constitution for Germany. The perspective of Weber is one of "idealism" due to the emphasis he places upon subjectivity and a view that "emphasizes the intersubjective realm of human experience through investigations of meanings, ideas and actions of people and how they reflect the world in which we exist." (Lukas, nd) Weber's attempt at sociology was to get inside the mind in what is referred to as an "intuitive grasp" (Williams, 1995: 15 cited in Lukas, nd) Closely linked to this concept is social action and Weber states of this: "Sociology is a science which attempts the interpretive understanding of social action in order thereby to arrive at a causal explanation of this course and affects. (Weber, 1947: 88 in Lukas, nd) in fact, social action is one of the primary concepts held within Weberian sociology and social action was identified by Weber as "the behavior of individuals related to the expectations of others in society to which all humans attach subjective meaning." (Lukas, nd) There were stated to be four ideal types of social actions:
(1) Traditional - always so performed because of custom or habit;
(2) Value-rational - based on ultimate values, such as religion, in which an individual has rational goals but irrational means;
(3) Purposively rational - (sometimes called instrumental action -- in which the individual uses rational means to achieve an end; an example would be gaining an education to attempt to achieve greater wealth in society; and (4) Affectual - based on emotions -- a form of action that Weber said was quite powerful in society. (Lukas, nd)
Stated as another important contribution to sociology is Weber's "conceptualization of authority and forms of legitimation found in society." (Lukas, nd) Weber's interest was centered on "the subjective meaning and authority offered individuals, and he was particularly curious as to why people so commonly, and often so slavishly, listened to authority figures in society." (Lukas, nd)
The multi-causal conception of social class is also attributed to Weber and unlike the link posited by Marx between social class and strict relationship to the means of production, Weber grasped the meaning of shared life interactions as being the primary factor to define social class. The Weberian view held that dimensions of social class included those of:
(1) Power (property);
(2) Wealth (property indicated by individual's economic position); and (3) Prestige (related to one's integration in high status groups).
Weber also stated that 'social conflict' occurred from the abrasion of any of these dimensions with one another. It was noted by Weber how the spirit of capitalism falls under the influences of Protestant values including:
Asceticism;
This worldly orientation;
Systemic ordering of the individual's lifeworld and relationships;
Individualism;
The Value of Hard Work; and the goal of material success. (Lukas, nd)
Weber's multi-causality beliefs are still utilized in present day sociology. (Lukas, nd) Additionally, the conceptualization of Weber concerning the nature of bureaucracy which is "a form of capitalism" was viewed as a normative system. The expansion of certain types of bureaucracy were noted by Weber as being 'key' in the growth of industrialization. Weber's philosophy was one of rationalization or "the use of science, technical knowledge, and western ends-directed philosophy resulting in the loss of the essential mystery of the world -- that have come to characterizes industrial society." (Lukas, nd)
I. DEPTH
The work published by USACHPPM entitled "Workplace Stress" states: "The 1995 Department of Defense Worldwide Survey of Health Related Behaviors (DOD Survey) found that 69% of service members reported some job related stress and 16% reported being under a great deal of stress due to life in the military. Family stress was also high at 50%. The types of stressors varied depending on your sex. However, regardless of whether you are male or female on active duty, the top stressors were very similar." (2008)
Figure 1
Reported Levels of Stress in Military Life
Source: 1995 Department of Defense survey of health related behaviors among military personnel
Figure 2
Rank Ordered Sources of Stress among Military Personnel
Source: 1995 Department of Defense survey of health related behaviors among military personnel
Figure 3
A Stress Model
Source: 1995 Department of Defense survey of health related behaviors among military personnel
The work of Steven Pfanz (1999) entitled: "Psychiatric Illness and the Workplace: Perspectives for Occupational Medicine in the Military" relates that throughout the military, in "inpatient psychiatric wards and outpatient mental health clinics…psychiatrists and other mental health professionals are often faced with patients suffering from emotional distress attributed to occupational stress. " However, there has been little research concerning the impact of the military working environment on the mental health status of military employees. Job related stressors are stated by Pfanz to include "…job dissatisfaction, perceived harassment, homesickness, conflict with coworkers or supervisors, deployment, forced permanent change of station, poor evaluations, failure to be promoted, undesirable assignments, military discipline, and the stress of basic training." (Pfanz, 1999)
There is evidence that "some military veterans, especially Vietnam veterans with combat exposure, may be more prone to psychiatric illness, alcohol and drug abuse, underemployment, and decreased earnings than the general population." (Pfanz, 1999) Yet, research on this has not been conducted. Existing research focuses on the effects of combat exposure and "the genesis of post-traumatic stress syndrome. has been recognized that occupational problems are a frequently used diagnosis in military clinics, and this has been attributed to specific characteristics of the military environment." (Pfanz, 1999) Pfanz (1999) states that each year approximately 15% of the military workforce "will experience at least one episode of psychosocial disability and an additional 10% will suffer from problems related to alcoholism." Findings from research study state that up to fifteen percent of all "occupational disease claims and stress-related occupational disease claims are increasingly rapidly at the same time that all other disabling work injuries are decreasing. The number of stress claims increased 700% between 1979 and 1988, and the costs per stress claim average approximately $12,000 per case, twice the average cost for all injury claims. Of the total population of workers, 25% have significant emotional problems and 10% have a serious psychiatric impairment. These numbers are comparable to the incidence of significant emotional problems and serious psychiatric impairment in the general U.S. population. Estimates of the lifetime prevalence of all psychiatric illnesses combined range from 29 to 48%." (Pfanz, 1999)
The work of Robbins et al. states findings "…that a consulting psychiatrist saw 1.2% of all employees each year, but these employees accounted for 17% of all visits to the occupational medicine clinic. Thirty-three percent of all occupational medicine health care appointments and 26% of primary care medicine appointments deal with primary mental health problems. Workers with psychiatric illness have more lifetime worker's compensation board claims than all other workers. Individuals hospitalized with psychiatric illness are more likely to be occupationally incapacitated at 30- to 40-year follow-up: 58% of patients with schizophrenia, 42% of patients with schizoaffective disorder, 24% of patients with manic-depressive illness, 17% of patients with depression, and 2% of general surgery ward patients were completely unable to work because of their illnesses." (as cited in Pfanz, 1999)
A study reported by Schottenfeld and Cullen states findings that "…approximately 20% of all patients referred to an occupational medicine clinic experience persistent somatic symptoms for which no organic cause can be found. Nonetheless, the workers attributed these symptoms to hazards in the workplace and were often severely disabled by these symptoms." (as cited in Pfanz, 1999) the study reported in the work of Jenkins states findings that "…33% of 321 civil service executive officers suffered from minor psychiatric illness, including depression, somatic symptoms of psychological origin, and anxiety. These workers had higher rates of sickness absence, and only 50% of them were improved after 1 year. In working populations in Japan, the 6-month and lifetime prevalence of psychiatric illness has been reported at 8 and 19%, respectively. Among U.S. workers, the 12-month and lifetime prevalence of depression alone is 3.5 to 9% and 6.2 to 23%, respectively, for men and 5.2 to 17% and 9.5 to 36%, respectively, for women. These studies demonstrate that psychiatric illness is present in the workforce in significant numbers." (as cited in Pfanz, 1999)
The fact that there clearly are individuals in the workforce with psychiatric illness is recognized by employers. Pfanz relates that the general costs associated with mental illness in the workplace are "difficult to quantify in specific monetary terms, but they represent significant losses to the employer financially. These costs are incurred in part because of decreased productivity resulting from ineffective working, missed deadlines, mistakes, and faulty decisions. Increased workforce turnover is a particular problem among psychiatrically ill workers, resulting in increased recruitment and retraining costs to replace workers lost to mental illness. These workers are absent more often, have more accidents, and exhibit lower morale. Psychiatrically ill workers have greater levels of interpersonal conflict with colleagues, supervisors, and customers, leading to lost business and work time." (Pfanz, 1999) Jenkins states findings that "14% of all absences, 14% of all inpatient hospital costs, and 23% of all prescription drug costs are attributable to mental illness." (as cited in Pfanz, 1999) Approximately $150 billion is reported annually in workplace lost productivity and worker's compensation claims." (Pfanz, 1999)
The work of Sauter et al. states that the cost of mental illness "including medical costs, absences, lost productivity, and physical illnesses, run between $50 and $100 billion annually. For depression alone, the costs have increased from $16.3 billion in 1980 to $43.7 billion annually in 1990. These estimates include the costs of inpatient and outpatient mental health services, prescription medicines, psychiatric mortality, absenteeism attributable to psychiatric illness, and lost productivity resulting from psychiatric illness. In 1990, the estimated cost of absences attributable to depression alone was $12 billion. The costs for sickness absence attributed openly to mental illness are considerable, which does not take into account all the sickness absence caused by psychiatric illness but attributed to somatic complaints. Expenditures for mental health care account for approximately 10% of medical insurance plan costs." (as cited in Pfanz, 1999)
Pfanz states implications for the military and specifically that the assumption can be made that "the overall working population and the military population are roughly comparable…" (1999) the literature reviewed in the study reported by Pfanz appears to suggests "…a significant percentage of military personnel suffer from psychiatric illness or emotional distress. Furthermore, many of these individuals may not be recognized as suffering or receiving therapy. Psychiatric illness among military personnel exacts a toll on military readiness through personnel absences from work, poor performance, poor morale, reduced unit cohesion, accidents, and injuries. The financial costs of psychiatric illness to the government include inpatient hospitalization costs, prescription medicine costs, evacuation costs of personnel overseas, retraining costs to replace individuals discharged because of psychiatric disability and medical benefits paid to veterans disabled by psychiatric illness. " (Pfanz, 1999) it is critically necessary that the military, "regardless of the cause of psychiatric illness and emotional distress among military personnel…endeavor to reduce mental illness among its personnel to minimize the tremendous costs imposed on military readiness, government budgets and the emotional well-being of its troops." (1999)
The military is proactive in the identification of individuals with problems relating to substance abuse because the military understands that workers with chemical dependency exhibit higher absenteeism rates as well as injuries and even mental disorders. The problem that exists is the fact that members of the military "…often view the military mental health professional with suspicion because of fears that a diagnosis of mental illness will end their careers." (Pfanz, 1999) Oftentimes security clearance is denied individuals with a diagnosis of mental illness as well as pilots losing their flying status and other military members who are diagnosed with a mental illness being removed from duties that involve nuclear weapons. However, fears and the stigma associated with such a diagnosis may result, and in reality often does result in "…unnecessary adverse outcomes for both the individual and the unit. There is a tendency in the military for personnel "to view individuals who cannot fulfill their duties as a result of emotional distress as malingerers or weaklings. (Pfanz, 1999) This may even be the case among mental health care providers as well. The "more dramatic aspects of wartime activities have been established as precipitants of psychological stress." (1999) Additionally Pfanz states: "More recently, the deployment of units to a war zone and the unexpected mobilizations of reserve units were correlated with higher levels of psychological distress in those units during the Persian Gulf War. Peacekeeping missions, such as those in Haiti, Somalia, and Bosnia, can also be highly stressful. Hall hypothesized that peacekeeping soldiers experience distress as a result of the need to show passivity and exercise restraint of aggression in the face of real threats to personal safety, unlike wartime soldiers, who can relieve aggressive impulses legitimately in combat." (1999)
In the case of the individual who has psychological stress it is important to understand that "punitive measures or ignoring these complaints will likely only increase the individual's subjective distress and increase rather than eliminate symptoms. On the other hand, identification of the source of stress and appropriate interventions may allow the individual to return to full duty." (Pfanz, 1999) Pfanz reports that in a study of three military mental health clinics in peacetime Europe "work-related problems were identified by active duty mental health patients as the major contributors of their emotional problems." (Pfanz, 1999) Additionally, a separate study states findings that "…23% of active duty patients received a primary diagnosis of occupational problems. Occupation stress clearly accounts for a considerable portion of the mental illness in this population, even without considering the degree to which occupational stress contributed to the illnesses experienced by other patients with diagnoses other than occupational problems. The results of these two studies suggest that occupational stress may represent a significant health hazard among active duty personnel." (Pfanz, 1999)
The military today is facing an increase in challenges in what is an "era of downsizing" resulting in a "smaller force…being asked to fulfill a wide variety of missions across the globe." (Pfanz, 1999) This results in deployment with little to no warning and instead of the mission detailing who the enemy is the military personnel in today's service are "increasingly involved in unconventional missions, such as peacekeeping missions, in which the threat of violence is unpredictable and the ability to respond with deadly force is constrained. These changes create new sources of stress for military personnel to overcome." (Pfanz, 1999) Pfanz states that due to these challenges and the "changing face of the American military" that needed is an in-depth "examination of the relationship between the military work environment and the mental health of military employees is needed. The incidence of occupational stress among active duty personnel needs to be determined. The occupational stress contribution to mental illness in military personnel needs to be assessed, and it needs to be seen if occupational stress is more frequently a causal factor in psychiatric illness in the military than in the civilian population. Aspects of the military work environment that cause emotional distress need to be elucidated. The author has planned a series of studies designed to answer these questions. By gathering these data, interventions can be planned to mitigate the effect of stress caused by the military work environment on the mental health of its members. These interventions are envisioned as yielding both improved health and satisfaction of our troops and improved mission readiness and decreased government health care costs." (1999)
The Air Force Medicine work related stressor checklist stats that common sources of work stress include those as follows:
Traumatic events (major disasters, toxic exposures, witnessing severe injuries, suffering severe injury, etc.).
Conflict with supervisors.
Conflict with coworkers.
Change in work responsibilities, hours, or conditions.
New job position.
New career field.
Work overload.
Lack of job challenge.
Exposure to harassment.
Fear of job loss.
Disciplinary action.
Being bypassed for promotion.
Being promoted.
Low wages.
Role ambiguity.
Role conflict.
Long work hours.
Job conflicts with family time.
Inadequate job training.
Inadequate resources (staff, equipments, budget).
Unsafe job environment.
Poor physical work conditions:
Excessive noise.
Excessive heat or cold.
Overcrowding. Isolation.
Poor ergonomic office design.
Inadequate lighting.
Other potential sources of stressors that may stem from military life include:
Frequent family relocations.
Frequent, prolonged, and short-notice TDY's.
Long and irregular duty hours.
Difficulty sharing domestic and child care responsibilities (Air Force Medicine, nd)
Stated as the impacts of job stress are those as follows:
The impact of life stressors may show up in individuals at work in a variety of ways:
Reduction in the quality or quantity of work produced.
Frequently coming to work late or leaving early.
Increases in frequency of accidents and mishaps.
Alcohol or drug abuse.
Difficulty with supervisors.
Unwillingness by the individual to perform certain tasks.
Tendency to question and challenge previously accepted management practices.
Preoccupation with non-work related activities such as personal finances.
Reduced morale. (Air Force Medicine, nd)
As a general rule, actions to reduce or manage job stress should give high priority. Specific measures include:
(1) Foster general awareness about job stress (causes, costs, control).
(2) Improve communications:
Reduce uncertainty about career development.
Monitor progress and share that progress with your people.
Share information with your team.
Keep unit members up-to-date on relevant information.
Set up meeting for unit members to vent any concerns and ask pertinent questions.
(3) Ensure that the workload is in line with unit members' capabilities and resources.
(4) Clearly define roles and responsibilities of unit members.
(5) Give unit members opportunities to participate in decisions and actions affecting their jobs.
(6) Provide opportunities for social interaction among workers.
(6) Assess the risk of stress among unit members. This involves:
Looking for pressures at work which could cause high and long-
lasting levels of distress.
Deciding who might be affected by these.
Deciding what can be done to decrease the stressors.
Maximizing flexibility can help prevent and reduce work stress.
Actions may include:
Providing flexible work hours.
Giving time off for appointments.
Giving members a voice in the decision-making process when appropriate.
Clarify expectations from the start.
Organizational characteristics associated with low-stress work and high levels of productivity include the following:
A safe and healthy work environment.
Recognition of unit members for good work performance.
Opportunities for career development.
An organizational culture that values the individual unit member as well as a team approach.
Management actions are consistent with organizational values.
Examples of measures that can help to reduce the effects of stressful working conditions include the following:
Balance between work and family or personal life.
A support network of friends and coworkers.
Use of time management strategies, such as setting priorities.
A relaxed and positive outlook. (Air Force Medicine, nd)
The work of Lavelle (nd) entitled: "Understanding Stress" relates that stress can be defined as:
(1) the rate of wear and tear on the body; or (2) Any disruptive influence in a person: physical, psychological or spiritual; or (3) Anything that upsets the balance in the life of the individual.
Changes in the body resulting from chronic stress are stated to be those as follows:
Tense Muscles Quick Reaction Cramps, Headache, backache, fatigue
Rapid, shallow breathing More oxygen Hyperventilation
Increased Heart Rate More blood High blood pressure, heart attack
Digestion stops Not needed Ulcers, indigestion, colitis, diarrhea
Constricted blood flow Blood not required Ulcers, blackouts, skin problems
Increased perspiration Cooling down Loss of fluid, body odor
Bowels loosened Digestion stopped Spastic colon, colitis
Liver produces sugar Energy Hypoglycemia, diabetes
Increased red corpuscles Clots blood Clots in blood stream
Increased white cells Fight infection Immune system not function
Decreased in saliva Digestion stopped Dry mouth, poor digestion
Increased fat in blood Energy Cholesterol build-up. (Lavelle, nd)
Stress takes different forms according to Lavelle, who is a chaplain, the armed forces including the following forms:
(1) Physical stress -- can be caused by an injury, a virus, an extreme temperature change, a foreign body, exhaustion or many other irritants;
(2) Psychological Stress - usually from some form of threat to security, self-esteem, way of life, or safety. The threat produces fear. . .especially fear of loss. Another major threat is uncertainty. The greatest cause of uncertainty is change. Sometimes changes are also losses. The combination of change and of loss contributes enormously to excess stress; and (3) Relational Stress - comes from the relationships in life. The classic case example of how this works is when "The man gets yelled at while at work, so he goes home and yells at his wife. She gets mad and takes it out on the children, so they kick the dog, who bites the cat, who scratches the furniture, which makes the man angry.and starts the cycle over." Our life involves many relationships which can produce stress in our lives. (Lavelle, nd)
Some of the symptoms of this type of stress are:
- Communication Problems (Emotional Distance)
- Inappropriate Emotions (to Include: Anger, Crying, Laughter)
- Low work productivity
- Sleeping apart
- Back-biting and gossip. Cutting remarks in conversation.
- Building "sides" and allies
- Separate activities
Stress that the military family specifically experiences is stated by Lavelle ( ) to include:
1. Financial Pressures - Low pay and having dependents to support, coupled with the high cost of housing today, create a great deal of pressure in many people's lives.
2. Family Separation - Both during basic training and tours of duty, military men and women are separated from family members for extended periods of time. This separation makes an already peripheral parent even less involved in the development of the children, as well as less involved in the development of a relationship with the spouse. Additionally, reunification can be as stressful as it is joyful.
3. Geographic Mobility - Packing up your possessions and moving to another town is stressful for anyone. It often means leaving friends behind and no longer having the support of family members. Mobility may also involve additional expenses which can exacerbate an already stressful situation.
4. Isolation and Communication Barriers - Military personnel often feel isolated from their family because of long hours and temporary separations. Further, communication barriers add to an already frustrating lack of contact with family members. During basic training and tours of duty, the isolation and communication barriers are at their greatest.
5. Cultural Differences - Many military men who have served overseas have married women from other countries which introduces life-style differences and creates additional barriers to communication. This usually includes lack of support from friends and family for the women, which in turn creates more dependence on the relationship.
6. Lack of Family Support - Lack of consistent contact with one's family can produce a special feeling of isolation. It can also put pressure on an individual to create his own family prematurely, which has its own unique set of problems and stresses.
7. Living Abroad - When a family travels with the service member overseas, many problems similar to those discussed above can create stress within the family; isolation; lack of support from friends and family; difficulties in acculturation; increased dependency on a relationship.
8. Lack of Privacy - the military member's activities are closely monitored by their superiors. During basic training, field maneuvers, and combat situations, service members live and work together. Their activities are continually supervised. If there are problems at home or at work, the commanding officer knows about them.
9. Lack of Command/Military Support - Many in the military describe a double message they receive from command or the military system in general. The first message, "Your family is recognized in that we will offer services for family members to help you keep everyone healthy and happy at home." On the other hand, the second message is, "When it comes right down to it, your work is more important that your family. We really do not want you to bother us about them." Of course, the degree to which these messages are expressed varies from commander to commander; however, the consensus is that these dual messages do exist in one form or another. (Lavelle, nd)
Lavelle (nd) additionally states that common reactions to stress which are physiological include the following:
- Increased adrenaline: perspiration, high respiratory rate, high heart rate (pounding), high blood pressure;
- Dryness of mouth;
- Muscle tension;
- Trembling, nervous tics;
- Grinding teeth;
- Inability to sit quiet - hyper-motivity;
- Changes in menstrual cycles;
- Migraine headaches;
- Changes in diet (loss of or excessive appetite);
- Insomnia, fatigue;
- Tight or fluttery stomach;
- Cold hands or feet; and - Accident prone.
Psychological reactions to stress are stated by Lavelle (nd) to include:
- General irritability, hyper-excitation, or depression
- Impulsive behavior, emotional instability
- Floating anxiety with no identified cause
- Stuttering or other speech difficulties
- Overpowering urge to cry or run and hide
- Increased use of alcohol, tobacco, or drugs
- Frequent anger, frustration.
Lavelle (nd) states that academic reactions to stress include:
- Inability to concentrate
- Slow and erratic recognition
- Increase of errors when made to hurry
- Inability to organize
- Slow judgment
- Forgetfulness, procrastination
Performance reactions to stress include:
Rust Out Zone Optimal Performance Burnout Zone
Boredom Exhilaration Insomnia
Irritability Sharp Perception Can't Concentrate
Overqualified for work High Motivation Frustration,
desperation, irritability due to inability
Apathy, lethargy Mental Alertness Accidents, diminished memory
Erratic, interrupted sleep High Energy: waken renewed
Alcoholism / drug dependence
Change in Appetite Improved memory & recall Apathy
Decrease in Motivation Calmness under pressure Confused
thinking,
Loss of Perspective, Indecisiveness
Negativity in recall, thoughts Positive, optimistic Hopeless,
sense of doom, futility
Withdrawal, absenteeism Involved Withdrawal, strained relationships. (Lavelle, nd)
Lavelle (nd) relates that the individual can self-test for a stress-prone personality through answering the questionnaire as follows:
How to Tell if You are a Stress-Prone Personality
Rate yourself as to how you typically react in each of the situations listed below. There are no right or wrong answers.
4 - Always 3 - Frequently 2 - Sometimes 1 -- Never
1. Do you try to do as much as possible in the least amount of time?
2. Do you become impatient with delays or interruptions?
3. Do you always have to win at games to enjoy yourself?
4. Do you find yourself speeding up the car to beat the red light?
5. Are you unlikely to ask for or indicate you need help with a problem?
6. Do you constantly seek the respect and admiration of others?
7. Are you overly critical of the way others do their work?
8. Do you have the habit of looking at your watch or clock often?
9. Do you constantly strive to better your position and achievements?
10. Do you spread yourself "too thin" in terms of your time?
11. Do you have a habit of doing more than one thing at a time?
12. Do you frequently get angry or irritable?
13. Do you have little time for hobbies or time for yourself?
14. Do you have a tendency to talk quickly or hasten conversations?
15. Do you consider yourself hard-driving?
16. Do your friends or relatives consider you hard-driving?
17. Do you have a tendency to get involved in multiple projects?
18. Do you have a lot of deadlines in your work?
19. Do you feel vaguely guilty if you relax and do nothing during leisure?
20. Do you take on too many responsibilities?
TOTAL the higher the number, the greater your present stress level. (Lavelle, nd)
Burnout Inventory
Respond to this questionnaire by thinking back over the last six months of your life. Read each question and then give yourself a score for each one, ranging from "1" indicating "little or no change" in the last six months in the item, to "5" indicating a "great deal of change" in the item during the last six months. Allow yourself about 30 seconds for a response to each. Then add up the total number of points to the 15 items as your final. score for a maximum of 75.(51 or more means "Burn-out" and that you need to do something for healing quickly).
1. Do you tire more easily? Feel fatigued rather than energetic?
2. Are people annoying you by telling you, "You don't look too good lately?"
3. Are you working harder and accomplishing less and less?
4. Are you increasingly cynical and disenchanted?
5. Are you often invaded by a sadness you can't explain?
6. Are you forgetting? (appointments, deadlines, etc.)
7. Are you increasingly irritable? More short-tempered?
8. Are you seeing close friends and family less often?
9. Are you too busy to do even routine things like make phone calls, read reports and send out cards?
10. Are you suffering from physical complaints? (a lingering cold, headaches, pains etc.)
11. Do you feel disoriented when the activity of the day comes to a halt?
12. Is joy elusive?
13. Are you unable to laugh at a joke about yourself?
14. Does sex seen like more trouble than it's worth?
15 Do you have very little to say to people?
Score:
(Pelletier, K.R., Healthy People in Unhealthy Places, Delacorte Press/Seymour: Lawrence, New York, 1984; as cited in Lavelle, nd)
Lavelle relates that a self-assessment inventory was developed by psychologists Lyle H. Miller and Alma Dell Smith at Boston University Medical Center as follows:
Miller and Smith Stress Vulnerability Scale
How Vulnerable are You to Stress? Score each item from 1 (almost always) to 5 (never), according to how much of the time each statement applies to you.
1. I eat at least one hot, balanced meal a day.
2. I get seven to eight hours sleep at least four nights a week.
3. I give and receive affection regularly.
4. I have at least one relative within 50 miles on whom I can rely.
5. I exercise to the point of perspiration at least twice a week.
6. I smoke less than half a pack of cigarettes a day.
7. I take fewer than five alcoholic drinks a week.
8. I am the appropriate weight for my height.
9. I have an income adequate to meet basic expenses.
10. I get strength from my religious beliefs.
11. I regularly attend club or social activities.
12. I have a network of friends and acquaintances.
13. I have one or more friends to confide in about personal matters.
14. I am in good health (including eyesight, hearing, teeth).
15. I am able to speak openly about my feelings when angry or worried.
16. I have regular conversations with the people I live with about domestic problems, e.g., chores, money and daily living issues.
17. I do something for fun at least once a week.
16. I am able to organize my time effectively.
19. I drink fewer than three cups of coffee (or tea or cola drinks) a day.
20. I take quiet time for myself during the day.
TOTAL:
[to get your score, add up the figures and subtract 20. Any number over 30 indicates a vulnerability to stress. You are seriously, vulnerable if your score is between 50 and 75, and extremely vulnerable if it is over 75.] (Lavelle, nd)
Finally, Lavelle (nd) states that causes of on-the-job stress include the following:
1. Inadequate time to complete a job to one's satisfaction.
2. Lack of a clear job description, or chain of command.
3. Absence of recognition or reward for good job performance.
4. Inability or lack of opportunity to voice complaints.
5. Many responsibilities, but little authority or decision making capability.
6. Inability to work with superiors, co-workers, or subordinates because of basic differences in personality, values, and/or goals.
7. Lack of control or pride over the finished product.
8. Job insecurity due to pressures from within the organization, or the possibility of a take-over or a merger.
9. Prejudice and bigotry due to age, gender, race, or religion.
10. Unpleasant environmental conditions: cigarette smoke and other air pollution, crowding, noise, exposure to chemicals, commuting difficulties, or inadequate/non-working equipment.
11. Not being able to use personal talents or abilities effectively or to their full potential.
12. Problems at home: family worries, financial problems, alcohol/drug/gambling problems.
13. Fear, uncertainty, and doubt of personal abilities.
(Adapted from U.S. Department of Health and Human Services Literature; as cited in Lavelle, nd)
In order to gain an even better understanding of military stress this study looks to the work of Dale Collie entitled: 'Army Ranger Reveals How to Control Corporate Stress" states that needed is "something more than mood music, aroma therapy, and comfortable lighting to get beyond the stress of today's workplace. We're going to need management's attention because stress control is a leadership responsibility. The U.S. Army has plenty of experience with stress control as front line leaders strive to keep GIs on the job. Traditionally, the U.S. Army has lost as many soldiers to stress as to enemy gunfire - a ratio of 1:1. The most elite units trim this loss to a ratio of 1:10 - one stress loss for every 10 wounded soldiers." (Collie, 2008) These indeed are horrible statistics. Collie relates that every "front line soldier is critical to winning the battle. Commanders know that controlling stress under fire is as critical as food, fuel, and ammunition. The same holds true for corporate America. You can't get high productivity with high absenteeism." (2008) Combat leaders proactively address stress in the military through watching "for stress symptoms and take[ing] action. They are taught "…to know your troops, and be alert for any sudden, persistent or progressive change in their behavior that threatens the functioning and safety of your unit." (FM 6-22.5, "Combat Stress") There are six primary ways that front line leaders are instructed in which assist them in helping soldiers who are under severe stress. Those six are as follows and the 'Corporate Solution' is compared with each of these:
Army Solution - Step One: Reassurance
Corporate Solution: Some people need contact with the boss to assure them that things will turn out ok. Spend time to find out worker's concerns. Ask for their observations on recent events. Find out what they think about upcoming changes. Ask for their advice -- they'll admire you for demonstrating your trust. Simple remarks showing your confidence in workers can make a big difference.
Army Solution - Step 2: Rest and sleep
Corporate Solution: Its worth your while to offer some additional time off if stress is interfering with performance. Consider giving additional breaks to relieve mental and physical fatigue. Improved productivity will more than pay for the unstructured breaks that over-stressed workers will take on their own. Find out what's needed to help employees get more rest at home. Bring in experts to teach the importance of rest and relaxation. Take a look at that overtime schedule; the extra work might be taking its toll in absenteeism, illness, accidents, and attitudes.
Army Solution - Step 3: - Food and fluids
Corporate Solutions: You can influence how people eat by getting experts to teach the importance of proper nutrition. Make sure nutritious snacks are available alongside the junk food in vending machines. Provide healthy snacks mid-morning and mid-afternoon when energy levels begin to fade. The investment will pay off in better performance. Reward good health.
Army Solution -- Step 4: Hygiene - bathing, clean uniforms
Corporate Solution: A scheduled break to get cleaned up before lunch or after a hard day of dirty work can pay off in a big way. Make sure everyone has the right protective clothing for the job. Extreme temperature and dampness create stress that can be easily relieved by proper apparel and hygiene breaks. and, as surprising as it might seem, some employees do not have running water at home. Not all of them have hot water. Not all of them have washing machines. Make these things available at your workplace or find alternatives. One-time arrangements can go a long way in helping stressed workers get their emotions under control and get their productivity up where it belongs.
Army Solution - Step 5: Discussion - a chance to talk about what happened, to tell war stories
Corporate Solution: Everyone benefits from a chance to tell about what went on. Some people are more sensitive than others. There is often great value in routine meetings to kick off the shift or explain the day's activities. Scheduling time before or after meetings to talk about what happened can relieve stress for those in the spot light. Team discussions after sales calls can help stressed workers understand the results and focus on what needs to be done. In times of high stress, some people need to talk about what happened to others around them - family members, community tragedies. Managers can handle the day-to-day conversations and experts are available to address major stressors. Help workers tell their "war stories."
Army Solution - Step 6: Restoring identity and confidence with useful work
Corporate Solution: As soon as possible, over stressed workers need to return to their positions of responsibility. They need to see that (a) they can perform well (b) that management recognizes their efforts (c) and that life goes on. Emphasize small accomplishments. Find reasons to reward each person for their achievements. (Collie, 2008)
The work of Fiedler, Rocco, Schroeder, and Nguyen (2000) entitled: "The Relationship Between Aviators' Home-Based Stress to Work Stress and Self- Perceived Performance" reports an investigation into the relationship between domestic-based stress and pilots' perceptions of their effectiveness in the cockpit and in the office. It is stated in this report that despite "…the importance placed on the family as a source of social support, there have been few systematic studies of the relationship between pilot family life, workplace stress and performance." (Fiedler, Rocco, Schroeder, and Nguyen, 2000) it is reported that this study was part of a larger study however, this specific study involved 19 USGG helicopter pilots at two air stations who volunteered to provide responses to the questionnaires. The median age in this study was 32.9 years ranging between 26 and 47 with the average number years in the USCG being 9.7 and the average time on assignment was 1.8 years. Of these pilots 14 were married, and three were single with one being divorced. One pilot did not provide demographic information for the purpose of this study. Nine participants reported having dependents and nine reported no dependents. Measures in this study is reported to have been a modified version of Sloan and Cooper's questionnaire (1986) for the purpose of measuring the psychological aspects of stress. Assessed by the questionnaire were sources of stress, coping strategies, and self-reported outcomes of stress on performance.
It is stated that "Five sections from the larger battery of questionnaires are reported in this study. The sections measuring home stresses and job stresses each consisted of 29 items on a 5-point scale, with 5 indicating "Causes me very much stress" and 1 being "Causes me no stress." The section on "Effect of home stress on work" consisted of 12 items, again scored on a 5-point scale. Types of coping strategies were measured by 33 items on a 7-point scale, ranging from 1 for "Of no importance whatsoever to me in coping" to 7 for "Of paramount importance to me in coping." Self-perceived flying performance was assessed by a 15-item scale with a 5-point range. (Fiedler, Rocco, Schroeder, and Nguyen, 2000)
Findings in the study of Fiedler, Rocco, Schroeder and Nguyen (2000) are reported to be those as follows:
(1) Home stress, job stress, and self-perceived flying performance - as Home Stress scores increased, so did pilots' rating of Job Stress (r = .81, p. < 01). Also, the more home stress that was felt in the workplace (Home Stress at Work), the higher pilots' ratings of Job Stress (r = .80, p. < 01);
(2) Home stress experienced at work and self-perceived flying performance - Pilots perceived their own Flying Performance to be detrimentally affected when stress in the home carried over to the work setting. There was a significant relationship between Home Stress at Work scores and pilots' self ratings of Flying Performance (r = -.47, p.
(3) Coping strategies and self-perceived flying performance - the importance of home life in mediating stress was also seen when pilots rated the importance of various coping strategies. Coping strategies significantly correlated with higher ratings of Flying Performance were spouse/partner who had prior knowledge of flying or who flies (r= .47, p. < .05) and hobbies (r= .49, p. < .05). The coping strategy of living in a non-flying social environment was significantly related to a lower Flying Performance score (r= -.57, p. < .05); (3) From a list of 33 coping strategies, over 80% of pilots rated 11 coping mechanisms as having importance to paramount importance. The three most important strategies all involved family support. The first two, stability of relationship with spouse and a smooth and stable home life, were rated as important to paramount importance by 100% of the pilots. The third item, talking to an understanding spouse or partner, was rated as important to paramount importance by 89% of the pilots;
(4) Specific home stresses - of the 29 items measuring home stress, more than half of the pilots rated two items as causing moderate to very much stress: "Build up of tasks, duties, and things to do (63%)," and "Disagreements, arguments, different opinions (58%)." Another 12 items were rated as causing moderate to very much stress by over one-third of the pilots. On the other hand, more than 80% of the pilots listed seven home factors as causing them little or no stress;
(5) How home stress is experienced at work - the most frequently reported ways in which home stress was felt at work were fatigue and rumination about the home-based stress About one-fifth of pilots reported that they could usually or always tell when they were experiencing home stress at work by feeling tired due to disrupted sleep, having a tendency to worry, and intruding thoughts during low workload. Most pilots believed that home-based stress seldom or never was experienced at work by: decreased quality of preflight preparation (84%), increased alcohol consumption (95%), making errors without knowing why (74%), or making errors of omission (79%);
(6) Flying performance - Pilots generally rated themselves highly with regard to their flying performance measures. Of a possible range of 15 to 75, actual scores on Flying Performance ranged from 47 to 74 (mean of 63; median of 64). Almost all of the pilots (95%) rated their ability to cope with things that go wrong and their overall quality of performance as good to very good. Items receiving the lowest performance scores included 16% of pilots rating themselves as having a relatively moderate to high number of errors and 5% of them rated their errors as being of relatively moderate to high importance;
(6) Age and years in the military - Age and years in the USCG were not significantly related to the stress measures or flying performance; and (7) Aircrew vs. pilots - Data collected on aircrew were analyzed separately since the criterion measure of flying performance was focused on the pilot, not the aircrew member. There were no significant differences between aircrew and pilots on domestic stress, effects of home stress on the job, or level of job stress. There were also no differences between the aircrews by base location. (Fiedler, Rocco, Schroeder, and Nguyen, 2000)
Figure 4
Factors Important in Coping
Source: (Fiedler, Rocco, Schroeder, and Nguyen, 2000)
Figure 5
Pilots Rating of Home Stress
Source: (Fiedler, Rocco, Schroeder, and Nguyen, 2000)
Figure 6
Effect of Home Stress at Work
Source: (Fiedler, Rocco, Schroeder, and Nguyen, 2000)
Figure 7
Self Ratings of Performance
Source: (Fiedler, Rocco, Schroeder, and Nguyen, 2000)
It is noted in this study that as stress increased in the home that the "experience of job stress" also increased. Pilots under stress in their home setting were "tired and worried with recurring thoughts at work. The lack of a direct relationship between home stress and flying performance is similar to Sloan and Cooper's (1986) results for British aviators, as is the importance of indirect home-work interface on job stress and performance." (Fiedler, Rocco, Schroeder, and Nguyen, 2000) the findings in this study suggest that the very first "warning signs of home-based psychological stress may be more evidence in the daily work activities rather than in cockpit error." (Fiedler, Rocco, Schroeder, and Nguyen, 2000)
If the early warning signs were recognized at work by support services and management "they could provide timely intervention before the occurrence of more serious flying performance decrements." (Fiedler, Rocco, Schroeder, and Nguyen, 2000) Further research is needed according to Fiedler, Rocco, Schroeder, and Nguyen (2000) into the impact of the family "both as a source of stress and support" because this research could serve to assist the aviation community "make wise policy decisions regarding family-work issues and appropriate intervention, giving insight into the interplay of the pilot's coping strategies and personal support system.
The work of Friedman (2006) entitled: "Posttraumatic Stress Disorder Among Military Returnees from Afghanistan and Iraq" reports a psychiatry treatment of a National Guard soldier, who was assessed in an outpatient clinic "several months after he returned home from a 12-month deployment to the Sunni Triangle in Iraq, where he had his first exposure to combat in his 10 years of National Guard Duty." (Friedman, 2006) Prior to being deployed this individual, referred to in this study as 'Mr. K.' was successful working as an automobile salesman and as well was happily married with two children ages 10 and 12 years. Furthermore, Mr. K. was ongoing and social with a large base of friends and was very active in the church and community however, while serving in Iraq Mr. K.
"…had extensive combat exposure. His platoon was heavily shelled and was ambushed on many occasions, often resulting in death or injury to his buddies. He was a passenger on patrols and convoys in which roadside bombs destroyed vehicles and wounded or killed people with whom he had become close. He was aware that he had killed a number of enemy combatants, and he feared that he may also have been responsible for the deaths of civilian bystanders. He blamed himself for being unable to prevent the death of his best friend, who was shot by a sniper. When asked about the worst moment during his deployment, he readily stated that it occurred when he was unable to intercede, but only to watch helplessly, while a small group of Iraqi women and children were killed in the crossfire during a particularly bloody assault. Since returning home, he has been anxious, irritable, and on edge most of the time. He has become preoccupied with concerns about the personal safety of his family, keeping a loaded 9-mm pistol with him at all times and under his pillow at night. Sleep has been difficult, and when sleep occurs, it has often been interrupted by vivid nightmares during which he thrashes about, kicks his wife, or jumps out of bed to turn on the lights. His children complained that he has become so overprotective that he will not let them out of his sight. His wife reported that he has been emotionally distant since his return. She also believed that driving the car had become dangerous when he is a passenger because he has sometimes reached over suddenly to grab the steering wheel because he thinks he has seen a roadside bomb." (Friedman, 2006)
Moreover, invitations to social gathering have all been turned down and his employer, who has been quite patient has reported that Mr. K. is self-preoccupied, short with customers, makes many mistakes and is not functioning effectively. Mr. K. was previous top salesman at this dealership and his boss has exhibited a great amount of patience for Mr. K. Mr. K. has acknowledged "that he has changed since his deployment. He reported that he sometimes experiences strong surges of fear, panic, guilt, and despair and that at other times he has felt emotionally dead, unable to return the love and warmth of family and friends. Life has become a terrible burden. Although he has not been actively suicidal, he reported that he sometimes thinks everyone would be better off if he had not survived his tour in Iraq." (Friedman, 2006) Friedman states that this case history "presents several kinds of war-zone stressors that have been experienced by returning veterans from Iraq or Afghanistan" and states those are as follows:
(1) feeling helpless to alter the course of potentially lethal events; being exposed to severe combat in which buddies were killed or injured; having personally killed enemy combatants and, possibly, innocent bystanders; being exposed to uncontrollable and unpredictable life-threatening attacks such as ambushes or roadside bombs; experiencing postcombat exposure to the consequences of combat, such as observing or handling the remains of civilians, enemy soldiers, or U.S. And allied personnel; being exposed to the sights, sounds, and smells of dying men and women; and observing refugees, devastated communities, and homes destroyed by combat. A common denominator for many returnees is the experience of having sustained anticipatory anxiety about potential threats to life and limb at any hour of the day and at any place within the theater of operations. For many, such a sustained combat-ready orientation to the environment results in a pervasive and uncontrollable sense of danger. In Mr. K's case, this has resulted in a preoccupation with concerns about the personal safety of his family, manifested by being hypervigilant, overprotective parenting, grabbing the steering wheel from his wife because of a perceived threat, and keeping a loaded firearm within reach at all times. Such behavior has been explicated in terms of psychological models such as classic Pavlovian fear conditioning;
(2) two-factor theory;
(3) emotional processing theory; and (4) other models. (Friedman, 2006)
Friedman relates that those returning from military assignment and most particularly those military returnees from a war zone "face several psychological challenges including the shift away from an adaptive, continuous, combat-ready hypervigilent state. After many months of deployment to a war zone in which the threat to life and limb is continually reinforced by surprise attacks, direct assaults, deaths of colleagues, inadvertent civilian casualties, and narrow escapes, it can be quite difficult to settle quickly into quiet domesticity." (Friedman, 2006)
Stated as other major adjustments in the case of Mr. K. other major adjustments that were presented were those concerning the family and domestic environment. Mr. K has spent 12 months in "intense fellowship within a military unit that became his de facto family. Mutual interdependence, trust, and affection forged in the crucible of ongoing life-threatening combat altered his sense of personal and social identity. The abrupt separation from his military unit and reinsertion into the family environment has been a difficult transition. It must be understood, however, that he was not the only one who had changed. During his yearlong absence, his wife assumed many traditional paternal responsibilities, such as managing the finances and making important decisions concerning home and family. As much as she was delighted that he had returned safely, she was not eager to relinquish the checkbook and other recently acquired prerogatives to her returning warrior. Adjustment at work was also difficult for Mr. K. The intense cohesion of the military unit was far different from the climate at the automobile dealership. Furthermore, he found it difficult to feel challenged, fulfilled, or stimulated by selling cars because he was aware that only a few months earlier in Iraq, "on-the-job" decisions could affect whether he and his comrades lived or died. He also had difficulty concentrating on work because his mind was so often preoccupied with vivid re-experiencing of combat scenarios." (Friedman, 2006) There are varying degrees of adjustment between individuals in their success in "passage from the war zone to the home front with various degrees of success." (Friedman, 2006) While some people make this adjustment in mere weeks the requirement for others is much more time and many times assistance is required with a "significant minority" experiencing complete failure or "…in other words, readjustment is a complicated process with no clear demarcation points and no consistent time course." (Friedman, 2006)
Clinicians must be aware of the "complicated nature of readjustment" and while it is necessary to "consider the likelihood that post deployment difficulties for a particular patient may be par for the course and simply a minor setback in an otherwise normal readjustment trajectory. On the other hand, they must consider the possibility that reentry problems are manifestations of a clinically significant problem (such as anger/aggressive behavior, depression, self-blame, guilt, shame, suicidal thoughts, and alcohol/drug use) or a psychiatric disorder (PTSD, major depressive disorder, other anxiety disorders, or alcohol/drug abuse/dependence). The subsequent discussion is focused on PTSD, with the understanding that the clinician should make a comprehensive assessment that includes inquiry about other posttraumatic disorders that may be expressed alone or in combination with PTSD." (Friedman, 2006) Since the individual with PTSD generally is leery in seeking care "due to avoidant behavior or because of the stigma associated with seeking mental health care, the window to PTSD may be provided through the problems expressed by other family members as a result of marital discord, domestic violence, or children's difficulties at school." (Friedman, 2006) the diagnostic criteria for PTSD has three main symptom clusters:
(1) Re-experiencing;
(2) Avoidance/numbing; and (3) Hyper-arousal.
The remainder of the diagnostic criteria for PTSD is listed in the following figure,
Figure 8
DSM-IV-TR Diagnostic Criteria for Posttraumatic Stress Disorder
(DSM-IV-TR Code 309.81)
Source: Friedman (2006)
The first step a clinician must take is obtaining a brief history of the trauma of the individual. Secondly, routine questions about the war-zone trauma should be asked in the beginning of the clinical interview. These questions should not be restricted to males only since females are also being deployed to the war zone. Risk and protective factors are listed as follows by Friedman (2006):
Suicidal risk - Assessment of suicidal risk is important. There is evidence of a positive association between the number of previous traumatic events and the likelihood of a suicide attempt. Furthermore, PTSD is often comorbid with other conditions that are associated with suicidal behavior such as depression, substance use, panic attacks, and severe anxiety;
Danger to others -- There are no data to suggest that PTSD, per se, is associated with harm to others. As in the assessment of any other patient, the clinician should inquire about access to firearms or other lethal weapons, the prominence of aggressive impulses, and the comorbid presence of persecutory delusions;
Ongoing stressors -- After the euphoria of a safe return from the war zone has worn off, returnees may be faced with new problems (such as changes that occurred at home during their absence) or, more likely, with home-front problems that preceded their deployment to Iraq or Afghanistan. Most typically, such stressors include marital or familial discord but may also extend to workplace or social settings. Ongoing or secondary stressors are risk factors for the development of PTSD. In addition, people with PTSD often have impaired capacity to cope with the ordinary stressors of daily life;
Risky behaviors -- as with other psychiatric disorders, clinical assessment must address alcohol/drug abuse and dependence, impulsivity, potential for further exposure to violence, risky sexual behavior, and nonadherence to treatment;
Personal characteristics -- People exposed to extremely stressful events exhibit a wide spectrum of posttraumatic reactions, from extreme vulnerability to strong resilience. Indeed, most people exposed to such events never develop PTSD. Personal characteristics that appear relevant in this regard include coping skills, interpersonal relatedness, attachment, shame, stigma sensitivity, past trauma history, and motivation for treatment;
Social support -- Social support is a powerful protective factor. The protective aspect is influenced by the capacity of an individual to accept or utilize social support when it is made available. Acceptance of social support may be especially problematic in PTSD, where symptoms such as avoidance, alienation, and detachment impair the affected individual's ability to benefit from available marital, family, and social support. This impairment was certainly apparent in the case of Mr. K.; and Comorbidity -- the likelihood that a patient with PTSD will meet diagnostic criteria for at least one other psychiatric disorder is 80%. Such individuals are also at higher risk for medical illnesses. Therefore, any assessment of overall clinical risk must consider the contribution of comorbid psychiatric and medical disorders. In Mr. K's case, assessment of depressive symptoms would be a high priority. (Friedman, 2006)
Special assessment issues are addressed by Friedman including:
(1) Stigma;
(2) National Guard or military reserve service;
(3) Military sexual trauma; and (4) Survival after a serious injury. (Friedman, 2006)
In relation to stigma, Friedman (2006) states that it has been shown that military returnees "experience a strong stigma against disclosure of PTSD and other psychiatric problems." Additionally those who are most "symptomatic are most sensitive to such stigma, and consequently, least likely to seek mental health treatment." (Friedman, 2006) Repeated deployments of civilian national guard or military reserve service and this is problematic because these individual are "neither embedded within full-time military culture not residing on military bases alongside families who are similarly affected by repeated deployments, and they have much less access to the social support and family services available to full-time active-duty troops." (Friedman, 2006) Therefore, the stress of deployment may itself "exacerbate the traumatic stress of danger service in a war zone." (Friedman, 2006) Friedman (2006) states that this factor may provide an explanation of "why National Guard and reserve troops in the Persian Gulf War had a higher prevalence of PTSD and depression than active-duty personnel." (Friedman, 2006) in this particular situation concerning Mr. K. "…the sudden displacement from a military to a postemployment domestic environment posed a significant problem for Mr. K." (Friedman, 2006) in relation to military sexual trauma it is stated in the work of Friedman that military sexual trauma "has a higher prevalence among women the fact is that "the same number of men are affected, despite a lower prevalence, given the substantially higher number of male military personnel. Because group cohesion, interdependence, and mutual support are critically important within a military unit, sexual trauma is a betrayal, a blatant breach of trust and security that can precipitate a sense of apprehension and vulnerability." (Friedman, 2006)
In relation to 'survival after serious injury' Friedman states that most troops that have been wounded in the war zone are "surviving their injuries" due to "remarkable protective gear, medical advances, and evacuation procedures, 90% of wounded troops now survive serious injuries, sometimes with loss of limb(s), eyesight, or other permanent physical disability." (Friedman, 2006) Friedman relates that prior research on Vietnam veteran stress has found that individuals who have been wounded in battle "are at greatest risk for PTSD. As a result mental health status should be assessed routinely as part of any postinjury rehabilitation." (Friedman, 2006) Friedman states the fact that "…effective evidence-based psychotherapeutic and pharmacological treatments are available." (2006) Psychotherapeutic interventions include that of 'Cognitive Behavior Therapy' (CBT) which has been "designated as the treatment of choice in all PTSD practice guidelines published to date." These techniques focus on the "conditioned fear and cognitive distortions associated with PTSD" and according to Friedman "prolonged exposure is essentially an extinction paradigm in which patients are respectively exposed to intolerable traumatic memories through imaginal or in vivo experience." (2006) This is a process in which the patient constructs narratives concerning the most traumatic events in recall. Cognitive therapy and cognitive processing therapy both target the "trauma-related erroneous automatic thoughts associated with PTSD. Typical erroneous cognition include perceiving the world as dangerous, seeing oneself as powerless or inadequate, or feeling guilty for outcomes that could not have been prevented. Cognitive restructuring is the technique though which the therapists challenges such distorted beliefs, thereby enabling patients to overcome intolerable trauma-related emotions such as guilt and shame." (Friedman, 2006) Both exposure and cognitive therapies are stated to have been successful and to have "equal efficacy." (Friedman, 2006) as well, both are stated to be "first-line treatments for PTSD." (Friedman, 2006) Other therapies are reviewed by Friedman and many of them are successful in treating work-related stress of military employees. Medications are also utilized toward this end and the following chart lists the medications approved by the U.S. Food and Drug Administration for Treatment of PTSD.
You’re 81% through this paper. Sign up to read the full paper.
Sign Up Now — Instant Access Already a member? Log inAlways verify citation format against your institution’s current style guide requirements.