Combat stress is still a murky and sometimes taboo element of soldiering, but one of the strangest discoveries is that the strain isn't evenly spread among vets from different countries. For example: A far higher percentage of American soldiers suffer from post-traumatic stress disorder after combat in Iraq and Afghanistan than British soldiers do.
Americans involved in those wars have suffered from PTSD at a rate of 30 percent, compared to 4 percent among Brits, according to a study published by the U.K.'s Royal Society of Medicine. And researchers say the difference isn't a reflection of the jobs Americans take on; it holds up in comparisons between units that saw equally heavy combat.
PTSD became a clinical condition after the Vietnam War — it entered the American Psychiatric Association's bible of disorders in 1980 — and now it's an everyday topic in the U.S. armed forces. "The simple but mind-bending truth," argues Ethan Watters, who's written a book on psychological ailments called Crazy Like Us: The Globalization of the Western Mind, "is that mental illnesses such as PTSD can be both culturally shaped and utterly real to the sufferer."
That might sound like another way of saying, "It's all in your head," but Watters means something more subtle. Since other scaffoldings Americans once used to make sense of self-sacrifice and wartime injury have broken down in the larger population — patriotism, religion — Watters argues that vets have to resort to whatever else is at hand.
Dr. Neil Greenberg, who co-authored the Royal Society study, agrees, up to a point.
"I think it's something totally about the medicalization of distress," he says. "In the U.K., our national approach towards psychological distress is one of, 'Crack on with it if you can.'" He says both countries deal with psychological illness quite well, "but deciding when someone is ill, or when someone is in a position where they should get on with things, talk to their friends, or go for a run or have a glass of wine — I think that bit is very different."
Which doesn't mean British soldiers cope more or suffer less; individuals just find different ways to cope. U.K. combat veterans seem to drink more (13 percent abuse alcohol) or suffer more garden-variety problems like depression (20 percent).
Greenberg also points out that British rates of PTSD in the general population are lower than American rates. "Military personnel are a subgroup of the civilian population," he says, "and if you look at the civilian populations in the U.S. and the U.K., the rates of PTSD are different there."
Nevertheless, his other studies have also found more mundane reasons for the combat stress discrepancy. One is length of deployment. British tours of duty tend to last about six months, compared with a year for Americans. The U.K.'s "harmony guidelines" prevent British personnel from spending more than 13 months in combat during a three-year period, and Greenberg says it's the total amount of time — rather than the number of deployments — that matters.
The U.K. also sends its troops to Cyprus after deployment to "decompress" for a day or two. The program was so successful it became standard British practice, and other countries, including Canada, have copied it. One to four days of R&R on a Mediterranean island with members of the same fighting unit apparently helps veterans come home with an easier mind. Maybe that's no surprise. "Third Location Decompression" has become a popular phrase in PTSD treatment outside the U.S.
The strangeness of PTSD — its tendency to appear and reappear and even shape-shift from one culture to another — doesn't mean it's just a phantasm.
"The argument as to whether adult traumatic experiences can cause discrete psychiatric disorder is over — they can and do," Greenberg writes in a separate study. But the way people cope is changing.
"Culturally, we are, at least in many Western countries, going through an 'age of trauma,'" he writes, and the cultural meaning of war has changed, even — or especially — for the men and women who fight and die.