In American veterans, rates of post-traumatic stress typically range from 10 to 17 percent, but among British veterans, the rate is closer to 4 percent. David J. Morris explains how that discrepancy has little to do with a “stiff upper lip”:
P.T.S.D. cannot be reduced to a simple matter of differing cultural attitudes. Within the field of P.T.S.D. research, there is a concept known as “the dose-response curve.” In simple terms, the more horror and death you are exposed to, the more likely you are to experience post-traumatic stress. (This is not limited to shooting combat; it encapsulates exposure to any life-threatening danger.) And Americans have been exposed to a lot more horror and death than their British counterparts.
When I asked Matt Friedman, the director of the National Center for P.T.S.D., about the differing diagnosis rates and what this might mean for American psychiatry, he seemed to grow irritated. “The Brits were down in Basra. Ain’t nothing happening down in Basra,” he said. In a letter responding to the original Lancet study that compared P.T.S.D. rates of American and British veterans, Charles Hoge and Carl Castro, P.T.S.D. researchers at the Walter Reed Army Institute of Research, made this very point, writing that “only 17% of UK service members reported discharging their weapon, compared with 77-87% of US service members; 32% of UK service members reported coming under small arms fire, compared with more than 90% of US service members.”
Morris zooms out:
The growing criticism of our current understanding of P.T.S.D. suggests that what was once ignored or treated as a failure of character—the soldier’s weakness—has now been medicalized to the exclusion of discussing its moral and spiritual dimensions. “It feels to me as if the U.S. civilian population has pathologized the veteran experience,” Elliott Woods, an Iraq veteran-turned-reporter, told me not long ago. “One well-intentioned person said to me the other day, ‘I can’t see how anyone could go to Iraq and not come back with P.T.S.D.’ ” Yet our social mechanisms for dealing with that problem are weaker than they should be.
The Dish 