Lethal cocktail that defines Extremist Groups 1)Isolation 2) Projection 3) Pathological Anger Isolation Isolation represents a key component in the restructuring or indoctrination phase of most groups, even those at the constructive end of the continuum, such as the military's bootcamps and corporate America's executive retreats. Isolation also appears to be the most powerful of the social dynamics operating in radical group processes. The isolation process begins as members become sequestered from their previous identities or memories. Members sometimes receive new names, and any contact with family members who do not belong to the group is either forbidden or strictly monitored. Ostensibly, this practice protects members from the contaminating influences of the outside world. In reality, it preserves isolation, which bolsters group solidarity. Radical groups isolate their members not only physically but psychologically as well. In short, they control what members think. Books, television, radio, and any other form of information challenging the tenets of the group are strictly censored. Simultaneously, the isolated individual gets bombarded by cause-related information in the form of "literature" or lectures by the group's hierarchy. Although some groups appear to be vociferous consumers of information from such sources as public access television, shortwave radio, and even the Internet, the group's leadership censors all of the information before disseminating it to group members. Communal living and daily meetings or prayer sessions strengthen the group's ideology. Oftentimes, these groups use extreme sleep deprivation, dietary restriction, and physical fatigue to indoctrinate members. As isolation increases, critical thinking decreases. Without access to alternative information sources, members encode new belief systems. Group tenets never are challenged, only recited. Platitude conditioning replaces reasoning processes. Although the isolation process itself is not pathological, the end result is. The extent of the deprivation and isolation yields an individual who responds to the group mandate with no individual thinking or decision making. Group leaders actively discourage critical, self-contained thought. Members perform such procedures as chanting and rhythmic, repetitive body movements for long periods of time. These actions create an autistic cognitive encapsulation, in other words, a closed belief system. In this cognitive vacuum, conspiratorial beliefs against mainstream society readily can develop . Over time, the rocking, chanting, rhetoric-espousing individual becomes unable to question either the group's tenets or its organizational authority structure. In short, new group members become isolated from past identities, family, other belief systems, information, and finally, from critical thinking. Group members who previously lived a life defined by a lack of purpose, security, and/or direction often welcome the isolation from outside influences and the structure, identity, and purpose that group membership provides. In any case, at this point, the socially, emotionally, and cognitively isolated members have become fertile ground for the seeds of the other two components of the Lethal Triad, projection and pathological anger, to take root. Projection Projection is a two-pronged process. First, the group projects responsibility for its decisions and direction onto the leader. Second, the group projects the cause for its perceived grievances onto some outside entity. These outside sources can be specific people or groups or merely the outside world in general. Each group requires a single authoritarian leader, who assumes absolute control of all group functions and decision-making processes. As members surrender critical thinking, they elevate the group leader to the status of absolute authority. Thus, a group leader may assume a title such as Supreme Commander or may claim to be the group's deity incarnate. Group members may pay homage to the leader in a number of ways, including shouting "Heil Hitler," bowing, or chanting the leader's name during "religious" practices. To remain in control of the group, the leader engages members in collectively orchestrated behavior, such as group prayer, meditation, or training sessions. Members abdicate all decision making and critical thinking to the group leader. Reality testing does not occur. Individual members who find themselves thinking critically of the group leader many times will revert to some form of isolation-producing cognitive exercise, such as chanting, exercising, or reciting organizational platitudes, to reduce the anxiety created by the mere thought of challenging the group leader. The following dialogue presents an example of how group members abandon critical thinking as they project responsibility onto the group leader.2 Question: "If the leader asked you to shoot your mother, would you shoot her?" Answer: "He would never ask me to do that." Question: "What if he did ask you to shoot her?" Answer: "She is not my 'spiritual mother,' she is only my 'flesh mother,' but he would not ask me to do it." Question: "What if he did ask you?" Answer: "It would have to be for a larger good than I could understand. He is my leader; it would be a bigger wrong to violate his order than it would be to shoot my mother." This exchange represents the typical answer provided by members of various isolationist cults when pushed to respond to the question of leader-initiated homicide. Members abdicate responsibility and accountability for their actions, which allows them to commit any act the leader requests. Pathological Anger The final component of the Lethal Triad, pathological anger, grows from the combination of isolation and projection. Collectively, group members see themselves as victims of an outside force. As they project blame onto this entity, they grow emotionally volatile. Their explosive anger can fuel actions that range from scapegoating ethnic minorities to bombing and gassing outsiders indiscriminately. As their anger grows, group members believe they are in a position of "righteousness" or "justification." Because of their isolation, group members come into significant contact only with others who share their world view and emotional reaction to it. They neither test nor challenge the group hypothesis and feel no sense of individual accountability. As a result, they can commit heinous acts without experiencing significant emotional turmoil or guilt. In essence, the group process has created situational sociopaths who suffer no remorse no matter what they do.

In trauma it refers to hypothermia (decreased temp), acidosis (low blood pH), and coagulopathy (decreased or increased clotting of blood). These are common complications of severe trauma and when they occur together the outcome is poor. Hypothermia, acidosis, and coagulopathy, in a severely injured and bleeding patient, will feed off each other and start a steep downward spiral toward death that is difficult to stop. It is important because much of the new research in trauma medicine is focused on treating the three components of the "lethal triad" in order to increase the survival of severely injured trauma patients. This is especially important for military surgeons and those in Iraq have focused heavily on studying/treating the lethal triad. Giant leaps in medicine have always been an unexpected side effect of conflict. This war has proven to be no different and has already begun to change the way we manage severely injured trauma patients.