How does one adequately describe something very few of us have experienced, such as the stress of combat? My vote goes to this narrative by a Navy pilot who experienced the stress of combat as a young pilot in Vietnam and as a seasoned reservist in Operation Desert Storm. As he related his experience covering 20-plus years, a recurring theme emerged—intense, prolonged stress grounded in high anticipation and anxiety, punctuated by relatively short periods of extreme terror.

What follows was described as average in any branch of the military, in law enforcement, and for teachers in many of our public schools!

The mechanism our brains use to handle stress
is common to all of us.

The pilot's story . . .

As the day begins, you feel like you have already run two to three miles, and you have only just left your bunk. Breathing is difficult and tiresome, so you sit around and sigh a lot. Your nerves are so shot that you become hypersensitive to the point that every little noise is frightening. In the briefing room, you look around to see who is not present  and think of who might not be there tomorrow, You fight to keep from losing your breakfast. After a while, food loses its taste and becomes low priority.

Extreme weight loss is common. If you are lucky, you learn to live on snacks and coffee—lots of coffee. As you walk out to your aircraft you try to convince yourself that everything is okay. However, you already have the shakes before your preflight is complete. The shakes, nausea, and anxiety are masked only by concentration on the mission ahead. Concentration on details is required because you know if you miss something during preflight or on some checklist, it could cause you not to come back. The stress continues to build and you are still on the ground.

You are now enroute to your target. There is no talking, only occasional forced laughter. Although you are in an air-conditioned aircraft, you have already sweated through your flight suit.  As you approach the target, you fight the ever-increasing adrenaline and the mounting anticipation.

Over the target, concentration becomes increasingly more difficult. In your headset you hear the enemy's target acquisition radar sweeping the sky looking for you. You now anticipate the sheer terror of hearing the solid tone indicating missile lock. There is an extreme natural impulse to jerk the plane around and "Get the hell out of there!", but you carry on to the target.

Due to the mounting stress, gaps are produced in your memory. Your recall is filled with blank moments, many of which are never filled. Adrenaline has filled your body to the point that you must put the plane on autopilot because you are shaking so badly, and your reaction time has slowed dramatically. When you get back, you have a hell of time getting out of the aircraft, and many times you need assistance. Your feel like your arms and legs weigh a ton and you move very slowly, but your thought processes are going a hundred miles a second. In a blur, many things stream through your mind: "God, I'm glad to be back….I'm sorry about those who did not come back. I'm really going to miss Buddy.   I wonder if the next time I won't come back?"

A pilot doesn't get out of his aircraft, debrief, sit down in the ready room, kick back, and think, "Well, I did my job for today." It's not an eight-to-five job. I can remember flying a mission in Vietnam and feeling so exhausted after it that I did not know how I was going to get up for my second and third missions of the day. By the time I had flown my last mission, I was so physically exhausted that all I wanted to do was fall into my bunk and sleep. But none of us could. You are so wired on adrenaline that it feels like your eyes are glued open—so you sit up and "talk" to your buddies. Extreme exhaustion makes communication in normal tones impossible. It is common to find yourself screaming and shouting at the person sitting next to you because you are sure that is the only way he's going to hear and understand you, even though the compartment is otherwise quiet!

In Vietnam, we never did eliminate or control the adrenaline, anxiety, or anticipation. We masked it long enough with alcohol or other drugs (especially Seconal) to allow us to pass out for a few hours.  We never did really sleep.

We "came to" several times a night experiencing feelings of dread and anticipation of our next mission, and at least once a week we awoke to the feeling. "Today my number is up." These thoughts were also lessened by more alcohol or drugs, and we could rest quietly, though knowing that in a couple of hours these feelings were also experienced by the other squadrons in Desert Storm.

This type of stress does not last for a week or two. In Vietnam, 50 to 60 line days were common. We flew seven days a week, completing two to three missions a day. The military keeps count of how many pilots and air crews are lost to missiles and anti-aircraft artillery, but there is no count of those lost to the deadly combination of physical and mental exhaustion produced by combat stress.

Our squadron took the dietary supplement be'CALM'd during Operation Desert Storm. be'CALM'd is an amino acid, vitamin, and mineral formulation produced by NeuroGenesis. We asked for it because a member of our squadron is a science teacher in civilian life, and he told us it can provide the nutrition needed to restore neurotransmitters that are heavily depleted as the body functions to inhibit the harmful effects of stress.

Half of our squadron was experiencing combat for the first time, and the rest were Vietnam veterans. We ranged in age from early 20's to mid-40s and were all in excellent physical condition. Due to current naval regulations, all naval personal undergo periodic urinary tests for drugs. None of our squadron members showed any evidence of drug use before, during, or after the study, the use (and availability) of alcohol was extremely limited.

After a week or so, we began to compare notes with other similar squadrons, and found in general, that:

—We had the ability to concentrate better before, during and after the mission, relax quickly after mission, sleep more soundly, and not awake in anticipation of next mission; and concentrate more going into the target. (Both veterans and rookies reported they did not feel the intense anxiety and anticipation reported by other squadrons.)

—Veterans who had earlier experienced adrenaline shakes indicated the shakes were less severe and shorter in duration (3-5 minutes).

—We were able to debrief more quickly and completely because details normally lost to the adrenaline rush could now be recalled.

—While other squadron members, who were not taking beCALM'd, became consumed with stress and began to eat, sleep, and live it, we would put the chocks under the wheels, shut down the aircraft, walk away, relax, fall asleep quickly, and have a little bit of peace.

—During  the  later part of war, and after the entire squadron had been under high stress for several months, one aircraft received severe anti-aircraft artillery damage to one engine and main wing spar. The crew reported they remained under control and focused. They were able to put the fire out, run all necessary checklists, return to base, debrief clearly, relax, and fall sleep. The skipper of this crew later reported that, based on his experience in Vietnam, he is certain he would not have been able to stay focused enough to have gotten the plane home if he had not had beCALM'd.

—During another mission, the crew of a severely damaged aircraft had to develop in-flight, real-time procedures to cover an emergency not covered in the manuals. This creativity was so significant that they were asked to recall the procedure, formalize it, and add it to existing manuals, even though it is well documented that creativity while under stress is rare.

—The squadron had greatly improved overall effectiveness and efficiency and we did not have to abuse alcohol and other drugs to relieve the effect of stress.

The antithesis of the experience recounted above is demonstrated by two cases in World War II . . .

None of the veterans, Russians or Germans, who fought during the siege of Stalingrad lived to age of 50. Few lived to 45, and most died soon after their 40th birthday. All of these individuals had suffered extreme stress 24 hours a day for more than six months.

A study was done by Stewart Woli reporting on the effect of stress by comparing the life expectancy of American men who had been in Japanese prison camps to that of Japanese men in American camps during World War II. 

The Japanese camps were extremely confining, had poor food in small quantities, and very little medical treatment.

The American camps provided food and medical assistance comparable to that received by the American population at large. Many U.S. camps allowed considerable freedom of movement for the prisoners.

In general, three times as many men died in the Japanese camps as in the American camps. Six years after their release, twice the expected number of those imprisoned in the Japanese camps died from heart disease, more than twice as many from cancer, and more than four times as many from gastrointestinal tract problems. Twice the number died from suicide, three times the expected number died as the result of accidents and nine times the expected number died of pulmonary tuberculosis.