The invisible division: US soldiers are seven times as likely as UK troops to develop post-traumatic stress

Something is happening at the end of the wars in Iraq and Afghanistan that mental health experts are finding hard to explain: British and American soldiers appear to be having markedly different reactions to the stress of combat. In America, there has been a sharp increase in the number experiencing mental-health problems, including post-traumatic stress disorder (PTSD). Between 2006 and 2007 alone, there was a 50 per cent jump in cases of combat stress among soldiers and suicides more than doubled. Why the precipitous rise? And why hasn't there been an accompanying rise in these symptoms among British troops?

The conclusion that British soldiers appear to have a different psychological reaction to the stresses of these modern conflicts was the finding of several recent high-profile studies. This year, in a Royal Society journal, Neil Greenberg of the Academic Centre for Defence Mental Health at King's College London and colleagues reported that studies of American soldiers showed PTSD prevalence rates of in excess of 30 per cent while the rates among British troops was only four per cent. UK soldiers were more likely to abuse alcohol (13 per cent reported doing so) or experience more common mental disorders such as depression (20 per cent).

Such differences were found even when comparing soldiers who served in the most intense combat zones. In addition, while researchers found increased mental-health risk for American personnel sent on multiple deployments, no such connection was found in British soldiers.

One theory to explain these differences is that the minds of soldiers are responsive to cultural expectations of how they should feel – and that those expectations can be different from one place (or time) to another. One theory to explain these differences is that the minds of soldiers are responsive to cultural expectations of how they should feel – and that those expectations can be different from one place (or time) to another.

"Despite some claims to the contrary," Greenberg et al write, "PTSD seems not to be a 'universal stress reaction', arising in all societies across all time. Evidence from both world wars suggests that the ways in which service personnel communicate distress is culturally determined and that the development of PTSD may be one more phase in the evolving picture of human reaction to adversity."

This suggests that the psychological reaction to war does not happen in a flash like a shrapnel wound. Rather, it evolves as the soldiers integrate their experiences with the values and expectations of their culture. British soldiers in the Boer Wars were likely to complain of joint pain and muscle weakness, a condition their doctors called "debility syndrome". In the US Civil War, soldiers often reacted to the trauma of battle by experiencing an aching in the left side of the chest and having the feeling of a weak heartbeat, labelled "Da Costa's syndrome". In the First World War, soldiers experienced "shell shock", with symptoms that included nervous tics, grotesque body movements, and physical paralysis. It was not until after the Vietnam war that soldiers began to describe their symptoms primarily in terms of the intrusive thoughts, memory avoidance and uncontrollable anxiety and arousal that makes up the core of the PTSD diagnosis.

The simple but mind-bending truth is that mental illnesses such as PTSD can be both culturally shaped and utterly real to the sufferer.

There is evidence, in short, to suggest that American and British soldiers come home to significantly different expectations for their psychological recovery and those expectations matter a great deal. In America, soldiers frequently return to a culture that fully expects them to be psychologically wounded by the experience.

Diagnosis of PTSD began to take shape in the US after the Vietnam war and represents much more than a clinical set of symptoms. It has become a world view; a weapon in a battle between a militaristic view of the world – where going to war and using deadly force can be both morally justified and personally uplifting – and a therapy view of the world, where violence is an aberration that inevitably damages the human psyche and spirit.

Originally called post-Vietnam syndrome, modern PTSD began in hothouse rap sessions held by Vietnam Veterans Against the War and supervised by antiwar psychoanalysts. The motivations behind the creation of the diagnosis are clear in early descriptions of post-Vietnam syndrome such as this one written by a young psychoanalyst named Chaim Shatan and published in the New York Times in the spring of 1972: These veterans were suffering because they had been, "deceived, used and betrayed" by both the military and society at large. That the creation of this syndrome would help the anti-war effort was clear. Shatan wrote in a memo to his colleagues at the time: "This is an opportunity to apply our professional expertise and anti-war sentiments."

The diagnosis of post-Vietnam syndrome was intended to highlight the psychological cost of participating in what many mental-health providers perceived to be an unjust war.

A generation later, the concept of PTSD at first appears to have come a long way from post-Vietnam Syndrome with its overt anti-war meaning. It has become much more clinical and de-politicised to the point where the military itself now recognises and employs the diagnosis. But American trauma counsellors still constitute a population with a direct intellectual lineage to the anti-war psychiatrists who forged the PTSD diagnosis. In their rush to help American soldiers, these healers often carry with them anti-war sentiments and other cultural assumptions about how the experience of war will manifest itself in psychological injury.

As several historians have pointed out, Vietnam veterans didn't return from that conflict with their PTSD symptoms fully expressing themselves. Many came home believing they were psychologically healthy, only to succumb – sometimes decades later – to cultural expectations that they were indeed suffering from the trauma of the experience. Vietnam veterans applying for PTSD disability doubled between 1999 and 2004.

"This raises the possibility of post-combat 'belief, expectation, explanation, and attribution'," wrote Dr David Marlow in a Rand report. "Participation in Vietnam caused veterans to see themselves and to be seen as a population suffering from a host of psychological symptoms. The public's view of them increased their stress, exacerbating whatever problems may have already existed." The reason that veterans have been prone to becoming psychological casualties, Marlow and others suggest, is because their unconscious minds were responding to a culture and a PTSD-focused mental-health community that predicted this turn of events.

This sort of cultural expectation has not yet fully taken hold in the UK where many remain resistant to a conception of the human mind as fragile in the face of trauma. Indeed many UK scholars and mental-health providers have pushed back at the spread of this American diagnosis.

"In a momentous shift, contemporary Western culture now emphasises not resilience but vulnerability," laments Derek Summerfield, of King's College, who has worked extensively with victims of war and genocide. "We've invited people to see a widening range of experiences as liable to make them ill."

Humans have suffered a great deal throughout history and have developed myriad cultural beliefs to sustain themselves in the aftermath of horror. PTSD appears particularly weak in this light. By isolating trauma as a malfunction of the mind that can be connected to discrete symptoms and targeted with specialised treatments, the disorder removes trauma from other cultural narratives and beliefs that might give deeper meaning to suffering. It claims to be value-neutral to cultural beliefs but this is problematic, given that those beliefs – be it God's plan for someone who's lost a child or patriotism for the soldier crippled in battle – are the very places where we once found solace and strength.

As it evolved away from Post-Vietnam Syndrome and into its modern clinical form, PTSD left behind the quests for social meaning in tragedy. In doing so, it has set adrift those struggling in the aftermath of trauma. In contrast to those angry but socially engaged Vietnam War veterans, the personal accounts of current-day US soldiers returning from Afghanistan and Iraq often seem pigeonholed into a PTSD diagnosis that is tied to a particularly modern style of lonely hyperintrospection.

The frustration, anger, and unhappiness of modern soldiers have been moved from the social (where one might find moral anger, nationalistic justification, or religious meaning to justify the sacrifice) to the biopsychomedical. Because the disorder focuses largely on internal states and chemical imbalances within the individual brain, this explanation for psychological problems often leaves the soldier – to borrow a recent US military marketing slogan – feeling like "an army of one".

Patrick Bracken, of Bradford University's Dept of Health Studies, argues that the emergence of PTSD is a symptom of a troubled postmodern world. "In most Western societies there has been a move away from religious and other belief systems which offered individuals stable pathways through life, and meaningful frameworks with which to encounter suffering and death," Bracken writes. "The meaningful connections of the social world are rendered fragile."

Although we might be able to ignore the absence of these belief systems during our normal day-to-day lives, truly traumatic events have a tendency to startle us into awareness of a heart-stopping emptiness. The diagnosis of PTSD can categorise some of our reactions to trauma, but in the end it is cold comfort. It cannot replace what we've lost.

Ethan Watters is the author of 'Crazy Like Us: the Globalisation of the Western Mind', published by Robinson. (£9.99). To order a copy (free P&P) call Independent Books Direct on 08430 600 030, or visit

Have you tried new the Independent Digital Edition apps?
ebooksAn unforgettable anthology of contemporary reportage
Teeth should be brushed twice a day to prevent tooth decay
Bryan Cranston as Walter White, in the acclaimed series 'Breaking Bad'
footballChelsea 6 Maribor 0: Blues warm up for Premier League showdown with stroll in Champions League - but Mourinho is short of strikers
Those who were encouraged to walk in a happy manner remembered less negative words
Arts and Entertainment
Princess Olga in 'You Can't Get the Staff'
tvReview: The anachronistic aristocrats, it seemed, were just happy to have some attention
Renee Zellweger as Bridget Jones
Life and Style

Board creates magnetic field to achieve lift

There have been various incidents of social media users inadvertently flouting the law

Life and Style
Stack ‘em high?: quantity doesn’t always trump quality, as Friends of the Earth can testify
techThe proliferation of online petitions allows us to register our protests at the touch of a button. But do they change anything?
Bourgogne wine maker Laboure-Roi vice president Thibault Garin (L) offers the company's 2013 Beaujolais Nouveau wine to the guest in the wine spa at the Hakone Yunessun spa resort facilities in Hakone town, Kanagawa prefecture, some 100-kilometre west of Tokyo
CSKA Moscow celebrate after equalising with a late penalty
footballCSKA Moscow 2 Manchester City 2: Premier League champions let two goal lead slip in Russia
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

IT Project Manager

Competitive: Clearwater People Solutions Ltd: Our client based in Chelmsford a...

Business Intelligence Specialist - work from home

£40000 per annum: Ashdown Group: An established and growing IT Consultancy fir...

Business Intelligence Specialist - work from home

£40000 per annum: Ashdown Group: An established and growing IT Consultancy fir...

IT Manager

£40000 - £45000 per annum + pension, healthcare,25 days: Ashdown Group: An est...

Day In a Page

Indiana serial killer? Man arrested for murdering teenage prostitute confesses to six other murders - and police fear there could be many more

A new American serial killer?

Police fear man arrested for murder of teen prostitute could be responsible for killing spree dating back 20 years
Sweetie, the fake 10-year-old girl designed to catch online predators, claims her first scalp

Sting to trap paedophiles may not carry weight in UK courts

Computer image of ‘Sweetie’ represented entrapment, experts say
Fukushima nuclear crisis: Evacuees still stuck in cramped emergency housing three years on - and may never return home

Return to Fukushima – a land they will never call home again

Evacuees still stuck in cramped emergency housing three years on from nuclear disaster
Wildlife Photographer of the Year: Intimate image of resting lions claims top prize

Wildlife Photographer of the Year

Intimate image of resting lions claims top prize
Online petitions: Sign here to change the world

Want to change the world? Just sign here

The proliferation of online petitions allows us to register our protests at the touch of a button. But do they change anything?
Ed Sheeran hits back after being labelled too boring to headline festivals

'You need me, I don’t need you'

Ed Sheeran hits back after being labelled too boring to headline festivals
How to Get Away with Murder: Shonda Rhimes reinvents the legal drama

How to Get Away with Murder

Shonda Rhimes reinvents the legal drama
A cup of tea is every worker's right

Hard to swallow

Three hospitals in Leicester have banned their staff from drinking tea and coffee in public areas. Christopher Hirst explains why he thinks that a cuppa is every worker's right
Which animals are nearly extinct?

Which animals are nearly extinct?

Conservationists in Kenya are in mourning after the death of a white northern rhino, which has left the species with a single male. These are the other species on the brink
12 best children's shoes

Perfect for leaf-kicking: 12 best children's shoes

Find footwear perfect to keep kids' feet protected this autumn
Anderlecht vs Arsenal: Gunners' ray of light Aaron Ramsey shines again

Arsenal’s ray of light ready to shine again

Aaron Ramsey’s injury record has prompted a club investigation. For now, the midfielder is just happy to be fit to face Anderlecht in the Champions League
Comment: David Moyes' show of sensitivity thrown back in his face by former Manchester United manager Sir Alex Ferguson

Moyes’ show of sensitivity thrown back in his face... by Ferguson

Manchester United legend tramples on successor who resisted criticising his inheritance
Two super-sized ships have cruised into British waters, but how big can these behemoths get?

Super-sized ships: How big can they get?

Two of the largest vessels in the world cruised into UK waters last week
British doctors on brink of 'cure' for paralysis with spinal cord treatment

British doctors on brink of cure for paralysis

Sufferers can now be offered the possibility of cure thanks to a revolutionary implant of regenerative cells
Ranked seventh in world’s best tourist cities - not London, or Edinburgh, but Salisbury

Lonely Planet’s Best in Travel 2015

UK city beats Vienna, Paris and New York to be ranked seventh in world’s best tourist destinations - but it's not London