Showing posts with label Stress Discipline. Show all posts
Showing posts with label Stress Discipline. Show all posts

Sunday, April 13, 2025

Introduction: Fear and Fight: A New and Better Understanding of Our Natural and Learned Responses to a Threat

As I wrote in my previous post, I have completed I have completed the first complete draft of the book that I've been researching and writing for the past ten years: Fear and Fight: A New and Better Understanding of Our Natural and Learned Responses to a Threat.

I shared the Preface to Fear and Fight in the previous post. In this post, I share the introduction:

Fear and Fight: A New and Better Understanding of Our Natural and Learned Responses to a Threat

CHAPTER 1

INTRODUCTION

The same survival mechanisms that kept our forefathers alive can help keep us alive as well! However, those survival mechanisms that can help us can also work against us if we don’t understand and anticipate their presence.

U.S. Army Field Manual 3-5.70: Survival

 Bruce Siddle is an internationally recognised authority on use-of-force training and the effects of ‘survival stress’ on combat performance. In Sharpening the Warrior’s Edge, Siddle (1995) refers to the well-known ‘fight-or-flight response’ as the ‘survival stress response’ (SSR), describing it as an automatic physiological reaction that prepares the body to either fight or flee when exposed to a threat. This reaction enhances strength, speed, endurance, and pain tolerance—traits that evolved to increase an individual’s chances of survival in life-threatening situations.

 Siddle (2005) explains that the SSR is primarily activated under two conditions: when an individual perceives an imminent deadly force threat and when there is minimal time to respond to that threat. He suggests that a person walking towards us with a knife from a distance of 500 yards (457 metres) is unlikely to activate our SSR, whereas being surprised by the same threat at a distance of 10 feet (3 metres) will almost certainly trigger it.

 I have faced a knife-wielding assailant while unarmed on two separate occasions, both of which involved the element of surprise and occurred at distances of less than 10 feet (3 metres). Yet, on both occasions, I did not experience a SSR reaction. The SSR was selected for in nature because it provided a survival advantage when one’s life was threatened. Where was my SSR when my life was threatened by a knife-wielding assailant in two situations that involved both a distance of less than 10 feet (3 metres) and the element of surprise?

 Siddle (2005) suggests that while the SSR was advantageous in our evolutionary past, it can interfere with modern survival skills such as close-quarter combat, firearms use, or evasive driving. He (Siddle 1995) refers to this as a ‘combat paradox’: the same response that once ensured our survival can now undermine it in specific combat scenarios. This raises an intriguing question: were my survival prospects if fact enhanced because I didn’t experience a SSR in these critical moments? Either way, the question remains—why didn’t I experience a SSR which is evolutionarily designed to promote an individual’s survival when my survival was directly threatened on two separate occasions? This book is the product of my search for answers to those questions.

 ‘Fight Activities’

The original intended audience for this book included individuals involved or interested in martial arts, self-defence, combat sports, security (such as security officers, bodyguards, and crowd controllers), law enforcement, and the military. But how can these diverse pursuits be referred to collectively?

 What they all share is a core focus: they train individuals to fight—for different purposes, certainly, but the ability to fight remains central. For this reason, this book refers to them collectively as ‘Fight Activities.’

 ‘Fight Activities’

The initial intended audience of this book was those engaged or interested in martial arts, self-defence, combat sports, security (security officer, security bodyguard, crowd controller), law enforcement, and the military. How can those activities be referred to collectively? To answer that question, we first need to ask what those activities have in common. Those activities teach trainees to fight, to fight for a variety of reasons but to fight nonetheless. For that reason, those activities will be referred to collectively in this book as ‘Fight Activities.’

 Fear and Fight

Our principal natural response to a threat is the emotion of fear—and the action tendency of fear is flight. Fight is not an action tendency of fear, despite what many suggest when referring to fight-or-flight and stress response concepts to explain our natural reaction to threats. Fight Activities teach people how to fight—for a variety of reasons, but to fight nonetheless. They provide ways and means to overcome fear in order to fight. These methods, combined with the learned fight behaviours they instil, form our learned response to a threat.

 This book explores both our natural response—driven by fear—and our learned response, focusing on the ways Fight Activities help us manage fear in order to fight. That’s why this book is titled: Fear and Fight.

 A New and Better Understanding of Our Natural and Learned Responses to a Threat

The subtitle of this book reflects a desire to deepen our understanding of our natural and learned responses to threats. The process that produced this understanding is explained by the work of Gary Klein in Seeing What Others Don’t (2013), where he discusses how insights can lead to more comprehensive and useful perspectives.

 Klein defines insight as an accurate and profound understanding, suggesting that it brings forth a new understanding that did not previously exist. This new understanding is better because it is more accurate, comprehensive, and useful than prior knowledge. Throughout this book, I aim to share insights that contribute to a new and better understanding of our natural and learned responses to threats.

 One of Klein’s paths to insight is curiosity, captured in the simple yet powerful question: ‘What’s going on here?’ This question serves as a catalyst for exploration, driving individuals to seek answers. For me, this journey began with my own ‘What’s going on here?’ moment—sparked by my lack of a fight-or-flight response during two life-threatening situations. That initial question led to answers, which in turn sparked more questions and deeper insights, ultimately shaping my understanding of how we respond to threats.

 Klein emphasises that insights transform our understanding and, in many ways, change who we are. They can alter our understanding by shifting the central beliefs in the story we use to make sense of events. This ‘new understanding can give us new ideas about the kinds of actions we can take; it can redirect our attention, changing what we see; it can alter the emotions we feel; and it can affect what we desire’ (Klein 2013, p. 148). This book aspires to facilitate such transformations for readers, encouraging a shift in how they understand, think, feel, and act in relation to our responses to threats.

 A Personal Perspective: Generalised Anxiety Disorder and Panic Attacks

What makes this exploration particularly unique is my diagnosis of generalised anxiety disorder (GAD) with panic attacks, which offers me a distinctive insight into both our natural and learned responses to perceived threats. Living with GAD means that my brain often interprets harmless situations as threatening, triggering responses as though the danger were real. This allows me to experience firsthand the instinctive responses to perceived threats, with anxiety and fear being the principal reaction. At the same time, the treatment for GAD involves learning to manage these responses, closely mirroring the way military, law enforcement, and self-defence practitioners are trained to regulate fear in high-stress situations. This parallel between therapeutic interventions and combat training demonstrates how learned behaviours can modify our instinctive reactions. Through this personal lens, I have studied our responses from the inside out, gaining an intimate understanding of how we handle both real and imagined threats. My experience informs every chapter of this book, offering a unique perspective on the interplay between natural and learned responses to a threat.

 Structure of the Book

Many people refer to the fight-or-flight concept to explain our natural response to a threat. In Chapter Two, we will explore how this widely accepted concept is based on a limited and flawed understanding of human survival responses. However, an accurate understanding of fight-or-flight still forms the basis for a more comprehensive view of both our natural and learned responses to threats.

 Chapter Three shifts focus to stress, another widely cited concept for explaining our natural response to danger. Since stress theory is rooted in the fight-or-flight concept, it shares the same limitations and flaws. Furthermore, because stress theory emerged from medical and biological research emphasising its negative effects on health, it has skewed researchers’ understanding of how stress plays a role in our survival responses.

 As I sought an answer to why I did not experience a stress response when confronted by a knife-wielding assailant on two separate occasions, I discovered that stress can be understood as a process involving physiological, emotional, and behavioural components. While this did not explain my reaction, it pointed me toward a deeper exploration of the emotional aspect, which proved instrumental in developing a new and better understanding of threat responses.

 Chapter Four examines emotion. Emotion, for theorists, is more than just a feeling. It’s a multi-component response to significant threats and opportunities, evolved to give an individual a survival advantage. In this chapter, an emotion process model is presented that offers a more accurate, comprehensive, and useful way to understand threat responses. This model will be applied throughout the rest of the book to investigate our natural and learned responses to a threat.

 Fear and its close cousin, anxiety, are the focus of Chapter Five, followed by a critical analysis in Chapter Six: if fighting is instinctively tied to fear, why do Fight Activities teach methods for overcoming fear in order to fight?

 The chapters in Part II dissect the individual components of the emotion/survival process, initially focusing on fear, and explore how interventions by Fight Activities help individuals overcome fear to fight. Many of these interventions rely on reason to suppress the emotional response of fear. Chapter 14 delves into the separation of ‘passion and reason’ and its implications for self-defence and combat training.

 Part IV applies the theory developed in earlier chapters to real-world contexts, including military strategy and self-defence. These chapters serve as case studies, showcasing how understanding fear and learned behaviours can inform and improve practical applications in survival and combat settings.

 Finally, Part V transitions to the post-phase of violent encounters, focusing on posttraumatic stress disorder (PTSD). PTSD is explored in depth, applying the insights from this book to better understand the condition and its treatment, along with related disorders such as GAD. My own experience with GAD has provided a firsthand perspective on these mechanisms. In fact, it demonstrates that PTSD and GAD share many similarities, both as evolved survival mechanisms and in terms of their treatment.

 A Broader Audience

While this book began as an exploration for those involved in Fight Activities—martial artists, self-defence practitioners, law enforcement, and military personnel—it has grown to encompass a wider audience. The principles discussed have far-reaching applications, touching on how we all navigate fear, anxiety, and survival in both extreme and everyday situations. Whether confronting life’s unexpected challenges or simply standing up to talk in a meeting, this book offers valuable insights into mastering fear and emerging stronger. Ultimately, Fear and Fight is for anyone who faces anxiety and/or fear—whether in combat or in daily life—and seeks to gain a deeper understanding of both the natural and learned responses that guide us through these experiences.



Tuesday, November 26, 2024

Expanding Horizons: The Boundless Possibilities of Understanding Threat Responses

When I began exploring our natural and learned responses to threats, I had no idea just how far-reaching this journey would be. What started as an investigation into fight-or-flight and stress training for survival has grown into something much larger—a foundation that connects to multiple fields of study and areas of practical application.

As I near the completion of my book, Fear and Fight: Understanding Our Natural and Learned Responses to a Threat, I’m starting to see the extraordinary possibilities that extend from this work. It’s not just about understanding fear or teaching self-defence; it’s about addressing core questions that affect how we live, learn, train, heal, and adapt in the face of adversity.

The Key Premise: Natural and Learned Responses to Threats

At its core, my book explores the ways in which humans respond to threats, both instinctively and through learned behaviours. It delves into the evolutionary roots of survival mechanisms and how these responses can be shaped, trained, and even transformed.

The insights I’ve developed are rooted in diverse disciplines, including psychology, physiology, military and law enforcement training, neuroscience, and self-defence. Whether it’s understanding the appraisal process during a threat or using stress training to regulate emotions, these ideas are designed to bridge the gap between theory and real-world application.

The Ripple Effect: Applications Beyond the Book

As I’ve worked through the chapters, I’ve realised that this understanding of threat responses is just the beginning. The possibilities for applying these insights are endless:

1. Anxiety Disorders and Mental Health

The connections between threat appraisal, emotional regulation, and stress training offer a new lens for understanding and treating anxiety disorders. This includes conditions like generalised anxiety disorder (GAD), panic attacks, and PTSD.

2. Women’s Self-Defence

By addressing the myths surrounding women’s ability to fight and defend themselves, this work provides a framework for self-defence training that goes beyond the physical. It emphasises the mental and emotional aspects of fighting, countering harmful stereotypes and empowering individuals.

3. Tactical Decision-Making

Insights from military and law enforcement stress training highlight the importance of preparing for high-stakes situations. This could revolutionise not only martial arts but also other fields requiring split-second decisions under pressure.

4. Martial Arts Pedagogy

Many traditional martial arts systems focus primarily on physical techniques. By integrating mental and emotional training, we could create a more holistic approach to teaching and learning combat skills.

5. Neuroscience and the Survival Process

Exploring the neurological basis of fear, courage, and resilience opens doors to understanding the brain’s role in threat responses. This could inform both training techniques and therapeutic interventions.

6. Fear and Resilience in Children

How do children learn to face fear and build resilience? This question connects to education, parenting, and youth development, offering valuable insights into nurturing emotional strength from a young age.

7. PTSD Treatment and Evolutionary Insights

The evolutionary perspective on PTSD suggests that our responses to trauma are not simply maladaptive but rooted in survival mechanisms. This understanding could lead to innovative treatment approaches that align with our biological and psychological realities.

8. Societal Responses to Perceived Threats

On a larger scale, understanding how individuals and groups respond to threats—both real and perceived—has implications for public policy, social psychology, and community resilience.

Beyond the Present: Future Projects and Collaborations

These possibilities inspire me to think beyond my current book. Could I write a follow-up focusing solely on anxiety disorders? Or create a manual for martial arts instructors to integrate stress training into their teaching? What about exploring fear and resilience in children or addressing societal fear responses in an increasingly complex world?

The work I’ve done so far has shown me that the understanding of threat responses isn’t just a niche topic; it’s a universal one. It touches on how we face challenges, how we grow, and how we connect with others.

An Invitation to Join the Conversation

As I reflect on these possibilities, I’m curious to hear your thoughts. Do you see applications of this work in your own field or life? Are there areas I haven’t considered?

This is just the beginning of a much larger conversation. Let’s explore it together.

Saturday, April 22, 2023

Why do warriors feel fear only after the threat has passed?

Recently, there have been a number of posts on Facebook from martial arts authorities that have focused on explaining emotion in relation to threats or asking questions about emotions in relation to threats in order to invite comments. The book that I am currently working on, Fear and Fight: Understanding Our Natural and Learned Responses to a Threat, is intended to deal with these issues in an authoritative way so I have decided to share some titbits from that book. This post concerns the issue of warriors only experiencing fear after a threat has passed.

Some of the following, including references, are taken from Fear and Fight and therefore the entire reference is not provided in this post.

Fear was selected for in nature because it conferred a survival advantage on an individual when their survival is threatened. Why then do warriors sometimes/often only experience fear after the threat has passed?

I regularly catch up with a friend who is a retired high-ranking police officer during which we often discuss material from my book. I once asked if he had experienced fear in a life-threatening situation in the line of duty. He didn't answer that question directly but instead asked a question of his own in relation to specific instances where his life was threatened in the line of duty but he didn't experience fear (overwhelming fear) until after the threat had passed. 'Why,' he asked, 'did I only experience fear which was selected for in nature because it conferred a survival advantage on an individual, after the threat had passed?' (or words to that effect).

Is this a common experience for warriors?

In a book that is promoted as representing a definitive collection of the most current theory, research, and practice in the area of combat and operational stress management (Combat Stress Injury: Theory, Research and Management, edited by C.E. Figley and W.P. Nash), William Nash, a former U.S. Navy psychologist who served in Iraq, provides the following description of warfighters’ combat action experience:

Before a planned combat action, most warfighters experience a period of uneasiness and agitation because of the unknowns they face and because, before the action begins, there is little they can do to actively master their stress. With the commencement of combat, however, the pre-action dread dissipates quickly, especially for veterans of combat. Most warriors then quickly get into a groove – a period of exceptionally low perceived stress, during which their thinking is clear, perceptions are sharp, and emotions are calm. The ‘in the groove’ period may last the duration of a combat action, if it isn’t too long or too overwhelmingly stressful. Once the action ends, however, perceived stress shoots back up as warfighters emerge from their emotional and physical numbness and review in their minds and perceive in their bodies all the dangers and horrors they may have experienced. The veteran warfighter quickly masters this rebound stress, however, and perceived stress returns to baseline. (2007a, 47)

Nash explains that many definitions for the word 'stress' has been offered but none has encompassed all the usages of the term even in the scientific community. I refer to this as 'the ambiguous concept of stress,' and as Hans Selye, the 'father' of the stress concept, famously said, 'Everybody knows what stress is, but nobody really knows.' In the case of the warfighters' combat action experience described above, stress is anxiety-fear.

The warfighters’ combat action experience can best be understood by dividing the experience into three temporal phases: before, during, and after a combat action experience. In emotion terms, the pre-event phase can be described in terms of anxiety (future anticipated threat) and the during-event phase in terms of fear (real or perceived imminent threat). In chapter four in Fear and Fight, we see that emotion is evolutionarily designed to promote homeostasis: ‘For example, running from a source of threat reduces the threat and tends to reestablish the condition that existed before the threat occurred’ (Plutchik 2001a, 120). The reestablishment of the condition that existed before the threat occurred describes the post phase of a threat event. This is our principal natural response to a threat, however, anxiety-fear-return to homeostasis phases do not describe the warfighters’ combat action experience as described by Nash above (although he did implicitly refer to the pre-event emotion of anxiety with his reference to uneasiness, agitation, and dread pre-action).

In terms of emotion phases, the principal natural response to a threat is anxiety-fear-no fear; the warfighters’ emotional response to a threat described above is anxiety-no fear (during phase)-fear (post phase)-no fear (return to homeostasis). What’s going on here? 

In the chapter on PTSD in Fear and Fight, I refer to Friedman et al and Friedman:

[Friedman et al] make specific reference to military personnel: ‘Trained military personnel may not experience fear, helplessness, or horror during or immediately following a trauma because of their training. They may only experience emotions after being removed from the war zone, which could be many months later’ (2011a, 756). Friedman expands the identified personnel who may not experience an emotional response at the time of a traumatic event to include, ‘military, police, and firefighter personnel who often report that they felt nothing, but that their professional training “kicked in”’ (2013, 551).

Warfighters experiencing no fear during the event/combat action phase is explained by Friedman et al and Friedman in terms of their training (see above), however, why do warfighters experience fear after the threat has past given that fear was selected for in nature because it conferred a survival advantage on an individual when their survival is threatened? 

The answer to that question lies within the learning aspect of PTSD discussed in Fear and Fight. In summary, a major feature of PTSD is the re-experiencing phenomena. When proposing his evolutionary theory of PTSD, Cantor suggests that the ‘re-experiencing phenomena of PTSD represent higher order memory and learning experiences. … Simply put, if ancestral individuals have had seriously threatening experiences, their long-term survival might be promoted if their lessons were not forgotten (re-experiencing symptoms)’ (2005, 123-124). Before Cantor there was Silove who suggests the same thing when exploring whether PTSD is an ‘overlearned survival response’:

automatic repetition of trauma memories once the survivor has withdrawn from the situation of danger ensures that memory traces signifying life threat are maintained in a highly active state and that they are rapidly retrieved when cues signifying the salient danger are encountered. Although the repetition of traumatic memories by the rehearsal mechanism triggers subjective distress in the survivor during the acute phase after trauma exposure, from an evolutionary perspective, the priority of survival learning overshadows the organism’s need for emotional stability. (1998, 186-187)

According to this view, the re-experiencing symptoms of PTSD are nature’s way of instilling and/or reinforcing the lesson that the traumatic event was dangerous and should be avoided in the future. 

In answer to my retired police officer friend's question, while his training produced a no-fear response during the life-threat event, nature still wanted him to learn the lesson that what he did was dangerous and it should that it should be avoided in the future (Don’t do it again!). Nature teaches this lesson in this case through fear being experienced after the threat has passed. It is still a survival response as it’s evolutionarily designed to avoid such life-threats in the future.

PS: My friend was happy to learn that this was a warfighter's combat action experience when I shared Nash's extract with him. While the previous sentence was designed to add levity, it does also show that knowledge about our natural and learned responses to a threat does alleviate stress, distress, confusion, etc, and which is why 'stress exposure training' that is used to better prepare military personnel for operational deployment, and most treatments for PTSD commence with a psychoeducation phase.

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.