B0038M1ADS EBOK

B0038M1ADS EBOK by Charles W. Hoge M.D. Page B

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Authors: Charles W. Hoge M.D.
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triggered a reaction similar to
being lost and "out of communication" on the battlefield. SSgt L's navigation skills failed him on one of his errands, and his inability to make contact with her after finding himself in an unfamiliar location caused him to
feel revved up, as if he were back on the streets of Iraq. Finding his way and
dealing with traffic back home seemed more stressful than driving in Iraq.
His body had not yet decompressed. He also had very little sleep during
his deployment, was still not sleeping well, and his temper was short-fused. He expected Sally to be available, and he reacted to her failure to pick up
her phone like he would react to one of his subordinates who failed to follow proper communication procedures.

    For both HM3 J and SSgt L, their bodies were reacting as if they were
back in the war zone. In PTSD terminology, these kinds of reactions are
called "hyperarousal" and "flashbacks," and are very normal after combat.
For both of these warriors, their bodies took over to protect them. They
did exactly what they had been trained to do and had done for months
during deployment, and would need to do again if they returned to the
combat zone, or if they faced other types of danger.
    HM3 J and SSgt L were experiencing reactions common during the
transition period after returning home from deployment. Medical professionals may label reactions such as startling easily, sleep disturbance,
anger, being hyperalert, and avoidance of going out as symptoms of PTSD
if they interfere with work or relationships. However, these postwar reactions can also be considered normal. It's not always clear where to draw
the line between normal and abnormal.
    How the Brain Reacts to Threat
    Extensive research has characterized the neural (brain) processes involved
in responses to high threat or danger. The "limbic system," the part of the
brain that acts as the alarm signal for the fight-or-flight reflex, consists of
neuronal pathways deep inside the brain (beneath the rational cerebral
cortex) that connect to the brain areas responsible for various physiological functions of the body, including heart rate, blood pressure, circulation, breathing, and hormone balance (e.g., adrenaline and the stress
hormone, cortisol). The limbic system takes over whenever there is high
threat, ensuring that the body responds rapidly. This system is critical for
ensuring that the body's reflexes will kick in when needed. The limbic
neurons trigger the release of adrenaline through the "autonomic" nervous system-the system of nerves that control unconscious physical processes in the body, including breathing and heart rate. Adrenaline tenses
muscles; increases alertness, attention, heart rate, and blood pressure; and
changes the way a person scans the environment for threats. The limbic neurons also cause the release of stress hormones, which increase endurance, as well as chemicals, similar to morphine, that dull awareness of
pain. The limbic alarm system of the brain "hijacks" the conscious rational
areas in order to ensure that the person's entire attention and focus is
directed toward survival.

    The primary emotion of the limbic system is anger. Fear is also present, but warriors learn to control this by falling back on their training.
Anger helps to control fear. Emotions other than anger are generally shut
down. While the speed of processing information increases, the ability to
be self-reflective or consider things in a rational sequence diminishes. In
times of danger, a moment of reflection may make the difference between
life and death.
    As an example of how the limbic system works, imagine walking
through a forest and encountering a snake just where you're going to step.
You instantly jerk your foot away to avoid stepping on it and save yourself
from being bitten. You do this without thinking. Only after this reflex has
kicked in do you notice that there was no snake in your path after all;

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