Covid-19, Systemic Racism, and Combat Operational Stress
By: Fsi Stanford
Tags: Mental Health, Military, Pandemic, Covid 19, Racism

Living through the pandemic has given one scholar at the Freeman Spogli Institute for International Studies a point of departure for understanding mental health in a new way.

Photo: Getty Images

By Herb Lin

Dr. Herb Lin is senior research scholar for cyber policy and security at FSI’s Center for International Security and Cooperation and Hank J. Holland Fellow in Cyber Policy and Security at the Hoover Institution, both at Stanford University.

Data collected by the National Center for Health Statistics (NCHS) and the Census Bureau revealed that over 40% of the U.S. population in the 3rd week of July 2020 exhibited symptoms of anxiety or depression disorder, which are clinical diagnoses.[1] The comparable figure from the same survey given in the January-June 2019 time frame was 26%. Symptoms of anxiety or depression disorder included frequently having little interest or pleasure in doing things; feeling down, depressed, or hopeless; feeling nervous, anxious, or on edge; and not being able to stop or control worrying.

A second poll conducted by the Kaiser Family Foundation (KFF) and released on April 24, 2020 found that over half of U.S. adults (56%) report that worry or stress related to the coronavirus outbreak has caused them to experience at least one negative effect on their mental health and wellbeing, such as problems with sleeping or eating, increased alcohol use, or worsening chronic conditions.[2] 40% report that worry or stress has led to problems with their sleep, while 15% had difficulty controlling their temper and 13% reported increases in their alcohol or drug use. (The reason that the KFF figure is higher than the Census Bureau figure is likely that the KFF was not probing for clinical diagnoses, which is a more severe condition than that measured by the KFF poll.)

It is useful to look at some of these mental health issues with finer granularity.

Depression. Individuals suffering from depression often lose their self-confidence and feel overly vulnerable or incapable. Sometimes, they exhibit emotional dullness or numbness. That is, emotions such as pride, shame, hope, grief, and gratitude are sharply attenuated, even when circumstances or events occur that would normally spark such emotions. Social companionship may become less of a priority, as individuals become more withdrawn and silent and they seek to isolate themselves. Individuals may be less talkative than usual and show limited response to jokes or cries. Personal hygiene and grooming also assume less importance, and the individual may present as more disheveled in appearance, with little professional bearing.

Anxiety. Anxiety is characterized as a disproportionate response to uncertainty about potential threats. People who suffer from anxiety are often fearful, restless, pre-occupied with worst-case scenarios, unable to relax, or physically agitated.

Mental distraction. People who are mentally distracted often suffer from forgetfulness and an inability to concentrate. They may have difficulty sorting out priorities or starting routine tasks. They may be excessively concerned with minor issues and exhibit a tendency to do familiar tasks and a preoccupation with familiar details. Conversely, they may have a hard time performing unfamiliar tasks. They may be restless, wandering aimlessly. Attention spans may be short, making it difficult for them to understand what others are saying. They are often unable to take the initiative in starting any activity, or they may take a long time to react to occurrences that normally require prompt attention.

Irritability and angry outbursts. Mild irritability may include angry looks, sharp words, tears, or profanity in response to normal, everyday comments or incidents or relatively slight frustrations or provocations (e.g., the closing of a window, an accidental bumping, or just normal verbal interactions). More severe irritability may include sporadic and unpredictable explosions of aggressive or violent behavior.

Sleep disturbances and fatigue. With sleep disturbances in play, falling asleep is difficult even when the objective situation is safe for sleep. The individual may awaken frequently and have difficulty going back to sleep. Sleep may be accompanied by nightmares or other terror dreams, involving, for example, images of oneself or one’s loved ones dying. Sleep of this nature is not restful, and the individual may wake up as tired as when that person went to sleep. Individuals may also sleep excessively — significantly more than 7–9 hours per day. When these individuals are awake, they often exhibit low energy levels when they expend a great deal of effort on only a few or minor tasks.

Hypervigilance. Hypervigilance is characterized by excessive sensitivity (such as a fight-or-flight response) to external stimuli that might signal danger, even if that stimulus is associated with a benign object, event, or person. Hypervigilant individuals often overreact or misinterpret unexpected noise, movement, or light. They may even overreact to reassuring information, perceiving such information as threatening.

Most interesting about the list of symptoms above is that it is taken from U.S. Army manuals intended to provide leaders of combat units with information about how to identify stress resulting from combat operations. U.S. Army Field Manual FM 6–22.5 (March 2009, Combat and Operational Stress Control Manual for Leaders and Soldiers) describes combat stressors as “singular incidents that have the potential to significantly impact the unit or soldiers experiencing them,” whereas operational stressors include “multiple combat stressors or prolonged exposures due to continued operations in hostile environments (emphasis added).” Sometimes, these stressors are related to multiple potentially traumatic events, which are events that are “perceived and experienced as a threat to one’s safety or to the stability of one’s world.”

Reactions to combat and operational stress are not the same as post-traumatic stress disorders (PTSDs). That said, they may well share some symptomatic similarities, and the distinction between the two are not always clear. One key difference is chronological sequencing — in PTSD, symptoms of disorder appear after the event(s) occur, though the definition of “after” may be somewhat fuzzy given the ongoing nature of operational stress.

A decidedly unscientific survey of friends and acquaintances of mine indicates that these symptoms and manifestations have been surprisingly common since March 2020, when the seriousness of the COVID-19 outbreak began to be understood. A second point whose relevance will be apparent below is that the COVID-19 pandemic is unlike other national traumas in that the social mechanisms of family, friendship, and companionship that often moderate the effects of stress are unavailable to much of the citizenry.

A personal anecdote is relevant here. Much of the period between March 2020 and the present has been spent under a shelter-in-place order of some kind. Individuals, especially those in high-risk groups (I am a member of one such group), are advised to stay home as much as possible to avoid exposure to others who may be carriers of the SARS-CoV-2 virus that causes COVID-19. However, it is also necessary to venture outside for exercise, such as walking.

I live in an urban neighborhood and when I go outside for a walk, I find I am constantly scanning the streets and sidewalks for other human beings. My immediate reaction to the sighting of any human being is to react to that human as a potential threat. I consciously evaluate the threat by trying to determine if that human being is wearing a mask properly. If my answer is negative, I immediately seek ways to escape — turning around, crossing the street, or allowing the person to pass but with my back turned and holding my breath for a few seconds after the person has passed.

I used these words advisedly — an unmasked person *is* a threat, and an encounter with that individual could kill me if the virus is present in his or her body. Given the incidence of COVID-19 where I live (San Francisco), the likelihood that the person is COVID-positive is low — almost certainly less than 10 percent. And the likelihood of contracting the virus from a single pass-by with another person outside is also low — probably less than 1 in ten thousand (more a speculative guess than anything else). But I *feel* threatened with bodily harm by every such person — and these are the neighbors among whom I live.

Where else can this phenomenon be seen? One can certainly imagine this phenomenon happening when soldiers on counter-insurgency missions come across a village in which 200 villagers are probably friendly or neutral (i.e., pose no threat) and one person may be carrying a grenade underneath a shirt. The likelihood that one person in the village would want to do those soldiers bodily harm is low, but it is not zero, and soldiers learn to regard everyone in the village is a potential lethal threat. Usually this does not lead to open uses of force, but the sense of threat under those circumstances cannot be eliminated — and they have to regard every person in the village as a potential threat until shown otherwise. That is, the default assumption must be that a villager is regarded as potentially threatening until evidence disproves that assumption.

Of course, the scenario above is no one-time event. As stressful as the scenario is, it is repeated many times over a tour of duty. These then are the multiple potentially traumatic events that the soldier perceives and experiences as a threat to safety — and what lead to the symptoms of operational stress. And soldiers in combat zones have usually deployed far from home, away from the social support that usually helps people to cope with mental and emotional stress. (So too is the case with public health guidelines calling for social distancing — hugs from friends and relatives not within my shelter-in-place pod are off-limits.)

I do not pretend for a moment that what I am experiencing in my walks around town carry in any way the same significance or risk as for the combat soldier. I have never been under actual fire, even though I have been a student of national security affairs for 40+ years. But it appears to me that living through the pandemic has some of the features, in a much less intense way, of that combat experience — and perhaps it has given me a point of departure for understanding, in a very small way, what ground soldiers on patrol in Iraq or Afghanistan must experience every day.

What does any of this have to do with systemic racism? There is at least one group of citizens that experiences these phenomena on a regular basis all the time, though in a different context. Nearly every Black American family knows to teach its children about how to avoid trouble with the police. For me (not a Black citizen), I was taught that as long as I did things that were not illegal, I would never get into trouble with the police — and for the most part, that has been my personal experience.

But that’s hardly the experience of Black Americans, who have often been stopped for the “crime” of driving or walking while being Black. From the perspective of many, and perhaps most, Black Americans, every police officer is a potential lethal threat. I stress the word “potential,” which contrasts with the word “actual.” But the essential facts about such encounters are that the police officer is almost always armed with a gun, that the legal system tends to give broad deference to the judgments of police officers in using force, and that competent legal services to defend the interests of Black Americans involved are often unavailable or unaffordable.

In any given encounter between a Black American and a police officer, the most likely outcome is certainly not that the citizen will die. But the probability of such an outcome is not zero, and as a number of widely circulated videos have demonstrated, the fact that the citizen is posing no threat to the police officer is no guarantee that lethal force will not be used. And where I have been dealing with the continuing operational stress of unmasked pedestrians who might be carrying the potentially lethal novel coronavirus for 4 months, African-Americans have to approach interactions with armed police officers with trepidation and care for all of their lives. It is easy to see how dealing with such situations repeatedly could lead to diagnosed clinical conditions such as operational stress disorder, and I have come to see the street protests against police violence as an inevitable end result of continued operational stress conditions for an extended period of time lasting many decades.

The police often invoke the same argument — they say that in the situations to which they are required to respond, there is always the possibility that the suspects will resort to lethal force, and absent any other knowledge of the situation, they too must regard the individuals involved just as the ground soldier must approach the villager. They argue they too must make split-second decisions about the use of force, and when they err and a citizen dies, it is because they perceived an immediate physical threat at the time that required a significant use of force in response.

I have no doubt that the police are sincere in making this argument. But their perception is profoundly shaped by the fact that as a society, we leave it to the police to address many problems that political leaders and communities are not willing or able to address. The vast bulk of activities in which police officers engage do not involve violent crime — one estimate places the amount of time dealing with violent crime at 4 percent, with serious violent crime at 1 percent.[3] More typically, they deal with issues related to the homeless, the mentally ill, those experiencing drug overdoses, those involved with minor traffic problems, school safety, and so on. For most of these types of incidents, the probability that lethal force will be necessary is very low — and it is likely that other responders, trained in de-escalation and protected but not lethally armed, could handle the vast majority of them as long as they had backup personnel properly equipped to deal with situations that turned out to involve the need for serious force.

In any event, the situations faced by police officers responding to a call are for the most part entirely different from those faced by ground soldiers in the field. Ground soldiers are forcible occupiers of a foreign territory, and the police are not, or at least should not be. At most, it is reasonable that they should be bringing lethal force to only a small fraction of the calls — the ones that involve violent crime — to which they currently respond.

At the end of the day, the COVID-19 pandemic has given me, for the first time in my life, a very small taste of what systemic oppression feels like. I’ve been victimized by the pandemic for 4 months and I’m having a hard time dealing with it. I can only imagine the consequences of what systemic oppression feels like to a combat soldier doing counter-insurgency work on year-long tours of duty or to a Black American living in the United States for a lifetime. It’s not exactly a silver lining to the pandemic, but maybe by helping me to understand these phenomena more deeply, I can become a better person on the other end of it.

[1] https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm

[2] https://www.kff.org/report-section/kff-health-tracking-poll-late-april-2020-economic-and-mental-health-impacts-of-coronavirus/, April 24, 2020

[3] https://www.nytimes.com/2020/06/19/upshot/unrest-police-time-violent-crime.html