Saturday, April 16, 2022

Combat-Related PTSD


I've been working on the chapter on PTSD in my Fear and Fight: A New and Better Understanding of Our Natural and Learned Responses to a Threat. Fascinating subject. In this post I will share some information about combat-related PTSD.

The first thing that needs to be understood about PTSD is that PTSD is a generic term and includes different types of PTSD. Different types of PTSD means different symptoms and different treatment.

Evolution and Posttraumatic Stress: Disorders of Vigilance and Defence by Chris Cantor is the first book to examine PTSD from an evolutionary perspective. Cantor argues that a confounding issue in the study of trauma is the blurring of boundaries between fear and loss-related phenomena. He suggests that the study of responses to extreme fear involves PTSD and that of loss involves depression: ‘PTSD might be more useful if it was restricted to the emotion fear; loss is adequately catered for by depression’

Cantor is comparing apples with oranges here. Fear is an emotion, loss is not. Appraisal theory has a stress appraisal being classified as either harm/loss, threat, or challenge. It is better to speak of threat-related and loss-related PTSD.

Cantor states that fear is the key emotion in (threat-related) PTSD. However, empirical evidence suggests that there is a unique relationship among PTSD, anger, and aggression, particularly in veterans. Why? Because warfighters are trained to cope with threats with anger and aggression. While a benign stimulus in PTSD is erroneously appraised as threat, the trained response of a warfighter/veteran to a threat is anger and aggression. That trained response is reinforced in combat when it is successfully employed to survive life-threats. (See Chemtob et al (1997) 'Anger regulation deficits in combat-related posttraumatic stress disorder' Journal of Traumatic Stress.)

Compare that to rape-related PTSD. In those cases, fear is the key emotion and the response is our natural or instinctive response to a threat rather than a learned/trained one.

There are many issues that arise from this conception of PTSD. For instance, Possis et al (2014) investigated driving difficulties among military veterans and the potential pathways that underlie risky driving behaviour. The risky driving behaviour pertains to driving behaviour in the relatively benign civilian environment upon return from deployment. Possis et al start off by explaining that military personnel deployed to Iraq and Afghanistan often develop mental health difficulties (e.g., PTSD), which may manifest as problematic driving behaviour: ‘Veterans may be more likely to engage in risky driving and to subsequently be involved in motor vehicle accidents and fatalities’ (2014, 633). Possis et al propose three mechanisms underlying driving difficulties in the population group under investigation: influence of fear, influence of anger and aggression, and influence of thrill seeking and sensation seeking.

When considering the influence of fear on driving difficulties among military veterans, Possis et al explain that,

Certain military experiences may make veterans more prone to fear-related driving difficulties. Military training itself may have an influence; the importance of ‘tactical awareness’ or being aware and able to react to danger immediately at all times is emphasised. Constantly being on guard and aware of potential threats might make an individual more apprehensive and anxious. In discussing his anxiety in dense traffic, the patient of one author (E.P.) commented that ‘my [military] training taught me it’s not safe to be boxed in. … individuals with significant driving anxiety are likely to make catastrophic predictions about driving situations (e.g., ‘trash on the side of the road could be an IED’) and are likely to attend to threat-related cues to the exclusion of other information. Additionally, these individuals are likely to engage in avoidance behaviour, such as steering clear of traffic or underpasses.’ (2014, 634-635)
The question here is, are the driving difficulities fear-related in combat-related PTSD or is it simply their training. The appraisal is in error, but does it produce a fear response? And what of a veterans training? They are trained to deal with fear and anxiety, e.g., stress exposure training (chapter 18 in Fear and Fight). Interestingly, a lot of therapy for PTSD is the same training provided to warfighters to better prepare them for operational deployment. Warfighters should already have a lot of the tools necessary to treat threat-related PTSD given they are the same tools they are taught to overcome fear and anxiety in order to fight.



Sunday, December 5, 2021

Kodokan Judo Belts and Snooker Balls

I was updating my book tentatively titled, The Science Behind All Fighting Techniques, and was looking into what a black belt originally meant when introduced by Jigoro Kano, founder of Kodokan Judo.

Kano introduced the black belt to distinguish between seasoned practitioners and others. Kawaishi introduced coloured belts for kyu grade because he was teaching in France and considered that Westerners needed some form or recognition for advancement.

So where did the colours come from for the kyu grades.

The International Judo Federation website refers to one theory that they were based on the colour of ... snooker balls. :) I just love this. Different colours with different values.

I've read a description for Kyokushin karate which refers to the colours of their kyu belts reflecting those of our 'aura.' The invisible energy fields that surrounds all living things apparently, although not so invisible if they formed the basis for a coloured belt grading system.

The martial arts (as opposed to the martial way) was developed by practical people for practical reasons. I just hate how it has be subverted and devalued by those who use it take people on a supposed 'magical mystery tour.'

If you want the whole analogy thing, which is the most important ball on the snooker table :) ... the white ball pots the coloured balls to win the game, including the black.

Thursday, November 11, 2021

Core of All Learning and Martial Arts/Self-Defence Instruction


My last post concerned the PTSD story based on my work for a chapter in my book, Fear and Fight: Understanding Our Natural and Learned Responses to a Threat. That chapter has been put on hold as I returned to the chapter on The Strategic Use of Emotion to Counter Fear in War. The book is a process and product of learning and insight. As I learn more and gain more insights, it impacts on previously written chapters that produced that learning and insights, and thus a re-think and re-write is required.

This post, however, is a return to the core of all learning. The core of all learning is the second chapter in my The Science Behind All Fighting Techniques because it is such an important concept. This has become so obvious in the past few weeks based on discussions with various martial artists.

In their book on research-based strategies for increasing student achievement, Marzano, Pickering, and Pollock (2001) explain that the identification of similarities and differences may be considered the core of all learning. Marzano, Pickering, and Pollock explain that research has identified four highly effective forms of identifying similarities and differences: comparing, classifying, creating metaphors, and creating analogies. 

We use the identification of similarities and differences to make sense of our world every single day. Understanding this concept enables us to use it consciously and deliberately rather than unconsciously and accidentally.


The martial arts is the very definition of the use of the core of all learning. The Karate Kid's 'wax on, wax off' is the very definition of the use of metaphors to teach karate techniques. Housner and Griffey (1994) use this movie as an example of the use of metaphor in motor skill instruction.

'Horse-riding' stance is another use of metaphor to teach martial arts techniques. In each case, as is the case with the identification of similarities and differences generally, the known is used to teach/understand the unknown. 

Of course the use of metaphor to teach martial arts techniques has its limitations for a variety of reasons. For instance, wing chun's 'goat gripping' stance does not help me understand this stance given that I have never seen anyone try and grip a goat. Ditto with Mas Oyama's birin, 'tail of dragon' stance. Even after watching Game of Thrones I have no idea what a tail of dragon stance would look like, not initially anyway.

How do you explain aikido? 'It's like jujutsu, but ...' What is pencak silat? 'It's an Indonesian form of karate.' Using the known to understand the unknown by identifying similarities and differences.

One of Jan de Jong's favourite theory questions in his jujutsu shodan grade was, 'What is the difference between o soto gari, o soto otoshi, and o soto guruma?' A more complete and insightful question would have been, what are the similarities and differences between those three techniques. 

The very reason for Minoru Mochizuki's kentai ichi no kata (kata of sword and body) is to demonstrate the similarities between sword and unarmed defences (see here). A sword defence is demonstrated followed with a similar but different (unarmed) defence. A more complete kata would be to focus on the similarities and differences because unarmed techniques can be/are compromised in order to fit with the theme of the kata, that being to demonstrate the similarities between sword and unarmed techniques.

In the current chapter I'm working on, one of the strategic uses of emotion to counter fear in war is the 'inculcation of hope.' Petersen and Liaras (2006), whose paper the chapter is based upon, use fear to understand hope. When those who argue that hope is not an emotion, they base their argument on a comparison between hope and the concept of emotions generally.


I was training some students in certain shime waza (strangulation techniques) from a prescribed attack and one technique did not 'feel' right. These shime waza are the same as those taught in judo so I studied the judo version. What I found was the judo techniques are applied with tori (the applyer) already behind uke (the applyee). The JDJ method was from a high punch where tori started off in front of uke and had to find a way to get behind them in order to apply the technique. This leads to all sorts of questions, however, knowledge and insight was gained through comparing those same techniques used in judo and JDJ's jujutsu.

I was reflecting on JDJ's jujutsu grading system and did so by comparing it to that of his aikido and other aikido, jujutsu, and karate grading systems. Far more insights were gained by doing so then if I'd simply attempted to study that grading system in isolation. In fact, the very concept of 'best practice' is based on comparison.


In another part of my life, I am a financial and corporate governance professional. What is the purpose of financial statements? It's to inform. How does it do so? Through the identification of similarities and differences. FSs are comprised of income, expenses, assets, liabilities, and owner's equity. Those are all classes of financial transactions. To better understand financial performance and financial position, you compare. Compare month to year-to-date, current year to previous year, other companies in the same industry, etc.

While most martial artists are comfortable with this concept, they often baulk at classification. This becomes very evident when I raise the issue that most, if not all, martial arts acknowledge the existence of throwing and takedown techniques but do not know how they are different. The common response is that the difference is academic and/or classification is an administrative exercise and serves no useful purpose (even though the very idea of throwing techniques and takedown techniques is an exercise in classification). Not so.

'Classification is often thought of as an administrative exercise and treated with disdain within the martial arts community. Lakoff (1987) warns against such a dismissive attitude. He suggests that there is nothing more basic to our thought, perception, action, and speech than classification and that without the ability to classify we could not function at all, either in the physical world or in our social and intellectual lives' (extract from my book).


Kano, the founder of Kodokan judo, was an educator (teacher). It is no wonder that he developed a classification system for judo. The idea of classification of techniques is seen in some aikido systems where their founders were also students of Kano.

One example, albeit a good example, of the benefits of classification is its use in 'previewing'. By previewing techniques, whether by classification or comparison, the student already knows what to look for in a defence before they even see it. They can call on their prior knowledge of similar techniques to help in learning the new technique efficiently and effectively.

Learning to think, teach, learn, and explain in terms of similarities and differences improves with practice. You'll notice the improvements in teaching, learning, and correcting/improving performances.




References:

Housner, L.D. and D.C. Griffey. 1994. Wax on, wax off: Pedagogical content knowledge in motor skill instruction. Journal of Physical Education, Recreation & Dance 65: 63-68.

Marzano, R.J., D. Pickering and J.E. Pollock. 2001. Classroom Instruction That Works: Research-Based Strategies for Increasing Student Achievement. Alexandria, Virginia: ASCD.

Petersen, R. and E. Liaras. 2006. Countering fear in war: The strategic use of emotion. Journal of Military Ethics 5(4): 317-333.

Tuesday, May 18, 2021

The PTSD Story Part 2: WWI leading to Medical 203

PTSD was introduced as a diagnosis in the third edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM) published in 1980, however, the PTSD story starts with World War I and the U.S. Army's Medical 203.

When writing about the ‘darker side’ of military mental healthcare, Russell, Schaubel, and Figley (2018) explain how all major European armies witnessed unprecedented, some would say epidemic, numbers of psychiatric casualties during WWI. Hundreds of thousands of military officers and enlisted members were being discharged, sent home, and given disability pensions for afflictions like shell shock and traumatic neuroses. European governments and military departments, they explain, became increasingly alarmed by this epidemic of war psychiatric casualties that existentially endangered the military’s capacity to fight and win wars, as well as producing skyrocketing disability pension costs threatening to bankrupt economies. In response, military leaders were forced to solicit the services of mental health professionals whose discipline was still in its infancy at that time.

What developed from the mental health professionals involvement came to be known as ‘frontline psychiatry’ where psychiatric casualties are treated as close to combat areas as possible with the firm expectation that the troops will return quickly to duty. Russell, Schaubel, and Figley explain that a comprehensive review of the military’s frontline psychiatry policies demonstrates its unquestioning effectiveness in preventing psychiatric evacuations. Note the focus on psychiatric ‘evacuations.’ The focus of the program is on preventing psychiatric evacuations not long-term mental health, which is reflected in the motto of the U.S. Army Medical Corps, ‘conserve the fighting strength’ (Jones and Wessely 2003), or as Russell, Schaubel, and Figley put it, to ‘preserve the fighting force.’

This is my own cynical evaluation of this process (which is part of the abovementioned darker side of military mental healthcare). How could frontline psychiatry fail? A soldier suffering combat stress reactions is taken off the frontline thus removing the stressor. They are kept close enough to the front to be reminded of their comrades fighting at the front, aka receiving support from their comrades, and how they are letting them down. The soldier returns to combat where their condition was indeed transient and they once again engage in combat in an effective manner. No psychiatric casualty going home. The same soldiers' fighting abilities may be impaired because of a mental disorder associated with the stress of combat and they are wounded or killed in action. WIA or KIA, no psychiatric casualty going home. They may desert because of their mental condition caused by the stress of combat, in which case they are a deserter and not a psychiatric casualty going home. They may abuse alcohol and/or drugs as a means of coping with the symptoms of their mental condition brought on by the stress of combat, in which case they are disciplined and possibly dishonourably discharged for behavioural problems. No psychiatric casualty going home. How could frontline psychiatry fail? It is genius, not unlike Catch-22.

In order to avoid a repeat of the same psychiatric attrition and subsequent disability pension costs of WWI, the Second World War saw the large-scale involvement of American psychiatrists in the selection, processing, assessment, and treatment of American soldiers. They were, however, hampered in their efforts because they were utilising a system of classification that was developed primarily for the needs of public mental health hospitals (Statistical Manual for the Use of Institutions for the Insane). ‘Psychiatric nomenclature which was barely adequate for civilian psychiatry was totally inadequate for military psychiatry’ (Brill 1966, 229), so the U.S. Army went about developing their own classification system. That classification system was published in War Department Technical Bulletin, Medical 203 issued on 19 October 1945 and came to be known simply as Medical 203 (Med 203). 

Med 203 included a 'combat exhaustion' diagnosis which we will explore in the next post.

This exploration will also demonstrate how the mental health discipline/professionals/practice came to gain credibility and how it is based in war time practices.

Sunday, May 9, 2021

The PTSD Story: Part 1


I am currently working on a chapter on PTSD in my book tentatively titled, Fear and Fight: Understanding Our Natural and Learned Responses to a Threat.

This chapter came about in the saw way this book came about. I was writing the conclusion and wanted a paragraph or two to explain how the new and better understanding about our natural and learned responses to a threat can help better understand PTSD and the treatment thereof. Research to provide that paragraph or two produced a great deal of information, so much so that a paragraph or two became a chapter in and of itself in my book.

The PTSD story is a fascinating story. It is a story that goes far beyond PTSD. It sheds light on the mental health discipline today and how it developed. It sheds light on the 'unholy alliance' between the mental health discipline and the military that poses dire consequences for military members and society as a whole. It sheds light on the 'unholy alliance' between the mental health discipline and many organisations. It sheds light on what is 'order' and how it becomes or is a 'disorder.' It is a fascinating story.

I will write a series of posts that discuss the PTSD story over the coming period of time, however, to start, what is PTSD?

There are a host of definitions of PTSD, however, the most accurate is:

PTSD is an initialism for ‘posttraumatic stress disorder’ which is a term that first appeared as an anxiety disorder in the third edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual for Mental Disorders (DSM).

Allow me to introduce you to the main characters in the PTSD story:

The APA is the main professional organisation of psychiatrists and trainee psychiatrists in the United States, and the largest psychiatric organisation in the world. The association publishes various journals and pamphlets, including the DSM. The DSM codifies psychiatric conditions and is used worldwide as a guide for diagnosing mental disorders. It is often referred to as ‘The Bible’ of psychiatry. The first edition of the DSM was published in 1952, and several new editions and revisions have since been released. PTSD was included in the third edition of the DSM published in 1980. The most recent edition of the DSM is the fifth edition, published in 2013, in which PTSD is classified as a trauma- and stressor-related disorder, a classification that is a major revision of how PTSD is conceptualised as we will see below. 

In the next post, we will commence the PTSD story not with the DSM but the US Army's Medical 203 which provided credibility and acceptance of the fledgling psychiatric and psychological discipline and laid the foundation for mental health practice as we know it.

Monday, August 24, 2020

'Junkie Jihadis'

Long story short, I was discussing the subject matter of my book (Fear and Fight: A New and Better Understanding of Our Natural and Learned Responses to a Threat) with a friend who served with the Australian Defence Force (ADF) in Afghanistan and referred to Colonel John M. House's, 'Soldiers must overcome their fear of death and injury in order to act and survive on the battlefield' (Why War? Why an Army? 2008). I said that this applies to equally to ADF personnel and  the Taliban militants they were fighting in Afghanistan. The ostensible explanation for how ADF personnel overcome their fear of death and injury on the battlefield is though courage, however, how do the Taliban militants do the same? My ADF friend immediately shot back with Taliban militants fight under the influence of drugs. 'What's going on here?'

The term 'junkie jihadis' is taken from an article written by Lukasz Kamienski titled, Junkie jihadis and the narcotic ways of war.’ Kamienski is also author of Shooting Up: A Short History of Drugs and War (2016). Kamienski would appear to support my ADF friend's assertion that Taliban militants/jihadis fight under the influence of drugs, however, the question, among many others, becomes, why?

One of the strategic uses of emotion to counter fear in war that Liaras and Petersen identify is the creation of anger. Sun Tzu also identifies this strategy in his The Art of War written some 2500 years ago when he explains to get soldiers to fight they need to be angered. Anger is the emotion of courage according to Biswas-Diener in Courage Quotient: How Science Can Make You Braver. Turning fear into anger in order to fight is also the principal strategy taught in women's self-defence.

Why would the Taliban militants/jihadis need to turn fear into anger in order to fight? Do they, in fact, need to overcome the fear of death and injury in order to act and survive on the battlefield? After all, do they not have enough reason to be angry, to hate (which is an anger-emotion family member)? America and their allies invaded their country, killing their comrades, friends, family, and fellow countrymen, destroying their homes, and occupying their country for two decades. This in addition to their religious beliefs behind their jihadism.

The question then becomes, if they do not need drugs to overcome their fear of death and injury in order to act and survive on the battlefield because anger and hate has replaced fear, why are they taking those drugs. And when I say drugs, I am referring to stimulants that are used to enhance combat performance (see Kamienski's Shooting Up). Not depressants or hallucinogenics, but stimulants. In their case 'captagon' which is an amphetamine based psychactive substance.