Momentarily I study 4000 pages of handwritten letters from the winter war 1940 till the end of the continuation war in Finland 1944-45,  altogether 5 years. There you can see that shell shocks and dissociative symptoms along with other symptoms we would label PTSD are frequent and present. The fear of war and other symptoms were passed on to the next generation. I suggest that the phenomenon correlates with the experience of war and should be found in e.g. Bosnia and Herzegovinia. The severity of PTSD is a correlate to circumstances and individual sensitivites as Viktor Frankl said: Those who do not loose their mind in certain circumstances do not have a mind to lose!

The estimated risk for developing PTSD for people who have experienced the following traumatic events is:                   

                     →Rape (49%)

                    →Physical Assault (32%)

                    →Other sexual assault (24%)

                    →Serious accident or injury (17%)

                    →Shooting/Stabbing (15%)

                    →Unexpected death of relative/friend (14%)

                    →Child's life-threatening illness (10%)

                    →Witness killing/serious injury (7%)

                    →Natural disaster (4%)

          (Perkonigg et al., 2000; Kessler et al., 1995; Ballenger et al., 2000)

http://www1.appstate.edu/~hillrw/PTSD%20MM/PTSD_riskfactors.html

Beatrice and Justin,

Thank you for your responses. Since my work focuses on the Roman army, and the Roman army was composed exclusively of male soldiers, I am gender-bound in my research. Please consider this factor in your responses. Beatrice has convinced me to conduct a second, future study involving female soldiers.

Val.

Justin,

What do you speculate are the main cultural components that correlate with a soldier's vulnerability to PTSD?

Val

I have studied the cultural aspects of PTSD and some lecture notes are on RG as "You ain't got the stare".  PTSD has been documented and presented in art for thousands of years and in all cultures.  The phenomenon appears to be more attached to basic human emotions than culture since even professional warriors in warlike societies have been documented as sufferers.  I attach the ppt presentation.

" suffer "survivor guilt," guilt for living while their buddy died". This is what you frequently find in my letters and you can be sure that the shell shock is an event that preceeded the PTSD. At that time when my father wrote the letters he studied psychology and analysed in detail the nightmares, cryings, shaking and other symptoms; it is a known fact in Finland that PTSD is at hand also in the next generation as an aftermath. The survivors were not allowed to talk about these event. Their letters were checked, the control commission walked along the streets. If we had to travel through the part of Finland that Russia had till late 50ties the windows of the train were covered from the outside, so nobody could see anything. Children were impacted by these events. My problem now is where to print these letters in Swedish.

Justin,

I agree with your connection between PTSD and modernity. The problem is how to define "modernity." When Gaius Julius Caesar and Cleopatra sailed down the Nile River together in 48 B.C., he considered Rome as modern and Egypt to be antiquated. Our challenge is to identify what factors in our current version of modernity correlate with a greater vulnerability to PTSD. Thank you for what I consider to be a step in the right direction.

Val

The 'horror of war' has changed in style rather than substance or quality.  Literature going back thousands of years indicates that PTSD or combat fatigue was well recognised by our ancestors.  It is interesting that stories from Ancient Greece have been used in PTSD treatment of combat veterans indicating a clear link throughout at least 20 centuries.

A classical Greek battle would have been every bit as horrifying as a modern drone strike and the aftermath of disfigured and dead casualties would have been similar rather than different and the effect of survivors as stark.  The most interesting feature of modern combat fatigue is that observed in remote combatants.  Even drone controllers who are very far from the action have been recorded as presenting with PTSD symptoms.  

Barry,

Thank you for your thoughtful comments. Will you kindly give some specfic citations and sources  to literature going back thosands of years which demonstrate that PTSD was well recognized by our ancestors?

Val

Herodotus, 440 BC , Marathon History, Book VI

A strange prodigy likewise happened at this fight. Epizelus, the son of Cuphagoras, an Athenian, was in the thick of the fray and behaving himself as a brave man should, when suddenly he was stricken with blindness, without blow of sword or dart; and this blindness continued thenceforth during the whole of his afterlife.

'Hysterical Blindness' is often a symptom seen traumatised soldiers 

Deuteronomy 20:1-9,

When thou goest out to battle against thine enemies, and seest horses, and chariots, and a people more than thou... the officers shall say, What man is there that is fearful and fainthearted? Let him go and return unto his house, lest his brethren's heart faint as well as his heart.

Ajax and Philoctetes

"I wanted to keep the pain to myself, son, but now it cuts straight through me. Do you understand? It cuts straight through me,“

                                                                           Philoctetes to a comrade

The poems Ajax and Philoctetes have been used in drama therapy for US soldiers and marines in a psychological technique similar to flooding.

Shakespearean references to PTSD the symptoms

Lady Percy describes Hotspur, her husband’s emotional detachment in Act 2, scene 4

In this description we can see all of the modern symptoms.

Dissociation (Tell me sweet Lord, what is’t that takes from thee thy stomach, pleasure and golden sleep.

Depression and emotional/sexual dysfunction (And given my treasures and my rights of thee to thick- eyed musing and cursed melancholy)

Sleep disturbance (In thy faint slumbers I by thee have watch’d and heard thee murmur tales of iron wars)

Hyper-vigilance and startle response (Why dost thou bend thine eyes upon the earth and start so often when thou sit’s alone)

And in thy face strange motions have appear’d such as we see when men restrain their breath

(is that the thousand yard stare?)

Barry,

Bravo! You have my profound respect. You are indeed a true scholar. Will you consider working on my proposed NEH grant regarding military imperialism? It appears at the head of the contributions section of my profile.

Val

In the Oxford Handbook of Warfare in the Classical World (Eds. Brian Campbell, ‎Lawrence A. Tritle) 2013 Phylis Culver describes the evidence that some form of PTSD was observable in Roman combat veterans (pp 256-259 Chapter 11) One reason why it may not be prevalent in the literature of the time is that it was regarded as shameful to be emotionally disturbed by warfare, a sentiment still around in the 1940’s where RAF Bomber crews showing signs of ‘battle fatigue’ were described as a "lacking moral fibre". Tacitus however does describe emotional events that might be recognisable as PTSD in the Agricola and the Germania.

The writing tablets of Vindolandum may shed some light on the emotional characteristics of Roman Soldiers. These letters written by ordinary Roman garrison troops (rather than state appointed propagandists) on Hadrian's Wall tell of the boredom, depression loneliness and homesickness felt by continental soldiers who were on what would have been a very bad posting.

I live on a street that has been here since my home town was occupied by mainly retired Roman Soldiers almost two millennia ago.

My town Lindum Colonia (Lincoln) was established by the 9th Legion ‘Hispana’ and I live about ten minutes walk from the north gate of the old Roman town and another ten minuets walk from one of the west gates. Less than 5 minutes away is the old west wall still visible after again, nearly two millennia.

As a settlement for retired soldiers there were probably a good number of 25 year combat veterans here who had some form of PTSD, even if convention meant they could not talk about it.

Justin

Armed Forces Health Surveillance Center,

Medical Survellance Monthly Report, Vol 20, Number 3 Page 3 March 2013

Mental health diagnoses and counseling among pilots of remotely piloted aircraft in the United States Air Force,  Jean L. Otto, Bryant J. Webber

Drone pilots and PTSD

http://www.afhsc.mil/viewMSMR?file=2013/v20_n03.pdf

Val

I would love to work on any project looking at historical PTSD.  

There is evidence in contemporary writings that Romans were not entirely inured to the violence in their society. Tacitus shows clear indications of vicarious remorse. While he was a senator he witnessed several political assassinations ordered by Nero and although he was not implicated in them himself he felt guilt.

"Our own hands dragged Helvidius to prison; ourselves were tortured with the spectacle of Mauricus and Rusticus, and sprinkled with the innocent blood of Senecio."

While that is not evidence of any kind of PTSD it does indicate similar feelings to ‘survivor guilt’ and if this is experienced then it is possible that more extreme psychological injuries could take place.

I just bought a great new book Invisible Romans by Robert Knapp.  It is about the ordinary Romans that history has overlooked and it contains a superb chapter on the life of the Roman Soldier.  

What is interesting is that they lived a highly privileged life and that many never saw combat.  Tax free pay, legal immunity, high status may have mitigated against some of the causes of PTSD and of course they were well looked after when their term of service ended, unlike many of our veterans (UK & US)

It might be the aftercare that mitigated against PTSD.  Many modern soldiers only manifest this after discharge when they lose purpose and contact with close buddies.  This does not appear to have happened in the Roman Army and that might be important.

Barry,

You make a very important point. Roman soldiers received free land grants in a communal setting when they retired. Usually these lands were in areas formerly held by the enemies of Rome. I believe that modern Colchester, England once hosted a community of retired Roman soldiers. They also received a substantial retirement sums.

Interesting discussion! In addition to asking the question about greater and lesser severity, I am wondering if this group has any thoughts about HOW SUFFERING MANIFESTS after war trauma. That is, PTSD as such is one possible manifestation of suffering after trauma among many. I would encourage people to look at the book Crazy Like Us, which--among other things--looks at the spread of "classical" Western PTSD in Sri Lanka after the tsunami because of the presence of Westerners who suggested the symptoms on TV and radio. I think we are using a culture-bound lens and overly limiting ourselves if we consider only PTSD and neglect to look at other post-war ways of expressing trauma.

Lisa,

Thank you for your contribution. We all recognize that PTSD can only be diagnosed   on an individual basis by a licensed psychiatrist or clinical psychologist under guidelines established by the "Diagnostic and Statistical Manual of Mental Disorders." Our discussion is a narrow one involving the influence of a core culture and military culture on the vulnerability of soldiers who experience close combat. In other words can cultural differences mitigate against the development of PTSD in close combat? Apologies if the topic is too narrow for your particular interests.

In frienship,

Val

Perhaps I did not express myself clearly. What I mean to say is, even a soldier who experiences close combat may develop trauma symptoms that do not fit the DSM categories--do not fit PTSD--but are still signs of suffering trauma. If we look only for what's in the DSM we may miss other trauma indicators. But if this does not interest you, that's fine. Best wishes. 

Val

As I mentioned before I live in a town that was established for Roman veterans (actually most of them were from the Iberian peninsula; 9th Legion Hispana)

Lincoln (Lindum Colonia) is one of the main towns on the Great North Road or Ermine Street.  We even have a re-enactor group called the Ermine Street Guard.  The North gate of Lindum Colonia is only about ten minutes walk from my house and I live in what was a part of the later (3rd century) settlement.

I have visited most of the best Roman sites in the old Empire and would love to go to many more, that current wars have made inaccessible.  

I worked on an archaeological project in my university some years ago.  A skull was found in a lock gate in my town and we got the job of identifying it.  It was mixed race and at first believed to be a murder victim (two distinct and unhealed axe wounds in the top of the cranium) .  When we got the date it was from the last days of the Romans in Britain.  This person was very likely from North Africa and demonstrated just how cosmopolitan the Roman Empire was.  

I wonder if that cosmopolitan nature of the Empire, with its cultural mixing is in anyway connected with the difficulty in detecting in its soldiers what we now call PTSD?

Lisa,

Your findings do interest me very much, and you make an important point. I apologize for not expressing myself correctly in my previous message. Thank you for your contribution.

Val

Justin,

I have been focusing on a comparason between the Roman legionnaires and modern American military personnel. A study that compares and contrasts the vulnerability of North Korean soldiers and American soldiers to the  trauma of close combat would be most interesting. This would involve the Korean War.

Val

Justin,

Is it possible to separate radical religious beliefs from radical ideological beliefs as justifications for armed conflict? They seem similar to me in this regard, but I have not conducted correlation studies on this topic.

Val

Justin,

I am more flattered that you think my question worthy of an answer. Radical behavior, regardless of its motive, is important to understand. Perhaps the leaders of superpowers let the influence that their countries possess, create an arrogance within them that they find difficult to contain in their foreign policy decisions. My dream is that one day a majority of the people on Earth will come to realize that all people are all fallible, mortal human beings that have far more in common than the differences that separate them. I call all men and women of good faith my surrogate brothers and sisters. Affluence may be a factor that deteriorates the moral code of some people to the point that they consider themselves to be exceptional. Exceptionalism can also be based on race, religion, ethnicity, financial status, etc.. Ethnocentrism was certainly true of many Romans at the height of the Roman Empire.

Val 

It was not the 'communist ideology' of the ordinary soldier that prevented an open display of PTSD in combat veterans it was the fear of incarceration, or the actual incarceration in the Gulag  of those suffering from it.  Like the Nazis and other extreme ideologies 'shell shock', trauma and PTSD could easily be interpreted by the Kommissars and Gauleiters  as lack of patriotism, defeatism and failure to acknowledge the infallibility of the 'leader'. 

Religious zeal similarly looks down on the 'weak', those who are 'weighed in the balance and found wanting'

People under the heel of Communists, Nazis, Islamists and the boot of other ideologues and ideologies suffer just as much trauma as those from more enlightened societies.  While our 'enlightened' society tends to ignore the 'shell shocked'  The societies motivated by zealotry tends to be far more brutal in suppressing it.

It is worth noting that Sturmbannführer Dr Rudolph Lange, commander of Einsaztgruppe 2, entrusted with exterminating all 'enemies of the Reich' found in the Baltic states complained to Reinhard Heydrich about the detrimental psychological effect that killing men, women and children was having on his men.  He was certainly talking about a peculiar form of PTSD that affects mass murderers in war.

The fanatical ideology of Lange and his men could not be questioned but he advocated using a 'less personal' method of killing than mass shootings.  

The industrialised mass killing that took place to protect the sensibilities of SS Extermination Squads is unique in human history.  The Nazis answer to avoiding PTSD in its own troops was to separate them from the killing as far as possible.  Not, it must be observed to actually stop the killing.

The deliberations at the Wannsee conference must rank as some of the most perverse in human experience but even the architects of the final solution took the effects of PTSD into account.  

Beatrice gives % of PTSD among victims, however current research is supporting the concept of poly-victimization and several categories tend to overlap with other forms of victimization.  A personal conversation with a soldier lead me to wonder about the  culmination of adverse live experiences:  war-time in addition to childhood and other adult trauma.  It could be that war-time experiences for some is subjectively more intense than some other ALEs and the subjective component of ALE is generally not taken into account in assessments, or maybe for some individuals military culture is itself an adverse life experience resulting in an inter-action effect.  Then there is the research on the culture of military where PTSD symptoms "shell shock" were attributed to weak willed men even as late as WWI and into WWII.  It wasn't until Vietnam Vets created small groups to support each other that PTSD became socially recognized and PTSD was included in the DSM III. Hence, it seems reasonable to conclude that stories of men experiencing PTSD symptoms were not handed down (included) over time for these were regarded as stories of weakness not strength.

Kathy,

You are making a very important point. Do you agree that cultural differences do not relate to a vulnerability to PTSD, but only to the willingness of a society to recognize that an anxiety disorder of this kind actually exists? I hope that Barry Turner will respond to your thoughtful comments. Thank you.

Val

A very interesting question.

As an Israeli I can see the changes on soldiers. On 1973 many soldiers were suffered from PTSD but the Israeli culture didn't accepted it and didn't recognize them as such. but saw them as weak. In the last 20 years there was a major change in the Israeli culture regarding PTSD since civilians became the front . Missle attacks on civilians changes everything since the battlefields turn to be everywere. In the news they started to talk about physical as well as psychologic woundeds.

Kathy and Val

Military culture is indeed an ALE for many soldiers and they are traumatised even before they see combat.  There is a good deal of sense in the observation that many individuals are already suffering from trauma from childhood and many soldiers have complex personalities often including lack of self esteem, compensated for by group identity and uniformity.

It is quite right that those treating the PTSD or combat trauma should look to earlier life experiences of the sufferer and address those along with the effects that war has caused.

Many of the military are recruited from poor neighbourhoods, from young people with limited prospects and often even deprivation.  They will often say that the military offered them a 'way out' of a dead end, losers lifestyle.  That represents in itself a kind of trauma, a long term trauma caused by lack of hope and opportunity.  

Our culture is based on 'winning' and is still infused with absurd notions of masculinity being expressed as dominance or strength.  Weakness is still despised even where it is a weakness without fault.  We use military analogies and language to describe overcoming a weakness/disease/disability.  

I deal with people affected by work related stress on an all to regular basis.  The workplace, while perhaps not as dangerous as the battlefield is an 'aggressive violent environment' where bullying is described as 'robust management', where line managers  are told to 'man up' and often where those on stress related sickness absence are seen as malingerers and compared to people who are absent 'with real illnesses"

PTSD is certainly linked to a culture where aggression is seen as positive, where the tough guy (however psychiatrically disturbed) is the hero and where the traumatised are seen as an embarrassment. 

I watched a great TV Documentary only last night on the painter Paul Nash.  His art changed greatly after his experiences in the trenches of WW, quite fascinating.

IN MY OBSERVATION OF THE SOLDIERS OF WAR IN RUSSIAN & AFGHAN AREAS, THE FACTORS NOTED ARE ONLY TWO: ONE IS THEIR MENTAL APPROACH OR BETTER SAY PSYCHE & SECOND IS CULTURAL BACKGROUND....THOUGH BOTH ARE INTERRELATED  ADDING TO THIS IS THE SOCIOECONOMIC VALUES AND THE PREFERENCES WHICH THEY HAVE SET FOR THEIR LIVES. THE CULTURAL ELEMENT IS DOMINATED BY THE ETHNIC AND RELIGIOUS ELEMENTS; THESE ELEMENT CHANGE ALL THE PREFERENCES, NORMS AND LIFESTYLE ASPECTS. KEEPING THESE FACTS IN MIND, THE SOLDIERS, HERE, HAVE A TOTALLY DIFFERENT CONCEPT OF WAR. SURPRISINGLY, THE NEW GENERATION SOLDIERS OF THE AREA DON'T TAKE WAR AS A STRESSFUL CONDITION BUT A THRILL SEEKING EVENT. AS FAR AS OLDER SLOTS ARE CONCERNED, THEY DO CONDEMN THE VIOLENCE BUT THE IDEAS AND CONCEPTS OF STRESS & PTSD ARE DIFFICULT TO BE CONSIDERED IN SOME SPECIFIC CATEGORY.   

Dear Asad,

Thank you for your important observation about the correlation between differing cultural norms and the vulnerability of soldiers to PTSD. My son enjoys the thrill of a roller coaster ride, but I find the ride to be most stressful. When I served in Vietnam as a medical corpsman, I met a few combat soldiers who revelled in the carnage of war. However, my qualitative observations are that the sentiments of  these few soldiers deviated from the sentiments of the normal distribution for the average American soldier. In other words  the military culture of a nation or state can operantly condition soldiers to view combat as a thrilling event rather than a dreadful event. In this situation,  the incidence of ASD and PTSD among these soldiers could be less. I believe that your concept applies to the ancient Roman legionnaires as well. You have a most interesting point of view.

Val

Combat soldiers who revel in the violence of war often stop doing that when their prop is taken away from them.  I have seen quite few ex-military tough guys develop serious neurosis when they are no longer with 'the boys'.  One reason veterans' clubs and societies are so strong is that many of those who have served in combat cannot let go and still wear the beret and the corp or regimental badges decades after their service.

The Romans knew about this and kept their veterans in close proximity.  It fosters a value system for the battalion/regiment/corp but it also offers support to those who though they many not admit to the world, can always tell their buddies about the terrible intrusive images that invade their waking and sleeping hours.

PTSD manifests itself in many ways but it is common even in those who deny it.   Achilles summed it up well.  Even though he was one who revelled in the combat he saw the faces of all those he had killed watching him from the far bank of the Styx.  Legend and myth I know but a powerful symbol of how the horror of combat, however thrilling invades the mind. 

Barry,

You remind us of the powerful insights of writers such as Homer, Virgil and Shakespeare who well understood  human emotions. I truly appreciate what Ernest Hemmingway was attempting to tell us in his " A Farewell to Arms." (1929). He knew the horrors of WW I.

Val

Hi all, I came into this conversation late, and while I understand the discussion is primarily a historical one regarding differences in military culture, I thought I’d offer some insight from a biological perspective.

Val—“Our challenge is to identify what factors in our current version of modernity correlate with a greater vulnerability to PTSD.”

I wouldn’t say that the “severity of PTSD” has increased, but more likely that the types of combat we engage in today are more likely to cause PTSD. When the original PTSD diagnostic criteria stated that the traumatic event had to be “outside the range of usual human experience,” what they meant (probably without realizing it) was that the traumatic event needed to be one in which our innate stress responses (i.e. fight-or-flight) had not adapted to handle. Stress with an “inescapable and uncontrollable” nature a very important aspect of what makes something traumatic. When you’re engaged in hand-to-hand or close-range combat, which was much more common in earlier wars, you are more likely to have some options to “fight or flee” so to speak—your innate stress response is activated and will allow you to try to do something to protect yourself. When you get sniped from out-of-nowhere or run over an IED, there is absolutely nothing you can do (i.e. the inescapable, uncontrollable trauma). Your fight or flight response is activated but never resolved (if you survive).

That being said, the single greatest risk factor in developing PTSD after trauma is social support. There are certainly genetic and environmental factors that influence this risk, but it appears that with the proper social support immediately following trauma, the likelihood of recovery is exponentially greater. I think this is where military culture comes into play in correlation with PTSD. If your military organization, your comrades, your officers, recognize PTSD as a brain injury (which it is) that needs medical attention just like any other injury, the likelihood of recovery is so much greater. When you have people telling you to “get over it” or that “everybody has nightmares, no big deal” you retreat into yourself and do not continue to seek support. Traumatic memories can get stored improperly in the brain in a way that they lack narrative context, so when reminded of those memories, a person may just feel them as a flood of emotions or flashes of visualizations that are completely overwhelming as if the trauma was happening all over again. But when you consciously give narrative context to what you see and feel by talking about it in detail (i.e. social support), those memories may eventually be associated and stored with that narrative context. Then, when you get reminded of a traumatic event, you remember it as you do most other memories, as a chronicle of what happened without the overwhelming emotions and fear. The goal in recovery from PTSD is not to forget the trauma, but to be able to remember it without being flooded with fear, guilt, pain, horror, and helplessness. That being said, the commiserating atmosphere of war vets sharing the same stories over and over again does not seem to be conducive to recovery, which may be related to the idea that when sharing stories with one another like that, they are able to remain somewhat emotionally detached (e.g. you rarely ever hear a vet say “this happened and it made me feel like I was completely damaged and would never be the same again and that I didn’t deserve to be happy).

Justin—“ Compare that to a culture where honor killings, bride burnings, genital mutilation, and/or acid attacks are common, where is it is morally acceptable (and likely non-traumatic) to kill or permanently disfigure family members.”

I just want to acknowledge that these events are plenty traumatic for the people they happen to…but I understand that you’re saying the people who instigate these things aren’t likely to develop PTSD afterwards, which is comparable to saying that rapists generally don’t develop PTSD. When you’re doing something on your own accord because you don’t know that it’s wrong, you won’t have that guilt. The apparent explosion (pardon the pun) of PTSD after Vietnam likely stemmed from the fact that so many of those soldiers went to war against their will, they knew what they were doing was wrong, and they were being forced to do it (i.e. the inescapable and uncontrollable aspect of trauma). Vietnam was possibly the first war with such pervasive opposition from both civilians and soldiers—many more people saw the World Wars as honorable and wanted to “do their part.”

Justin—“ I wonder what you think about the fact that facial ticks and exaggerated expressions, blindness, stuttering, and muteness were symptoms of "shell-shock" but are not considered or reported as symptoms of PTSD. However, it is common to say that "shell-shock" and PTSD are the same condition.”

I wouldn’t say that shell-shock or these symptoms were not PTSD, although we generally do not see these types of symptoms much anymore. It’s possible that something about the nature of the combat in World War I promoted these symptoms. The facial tics, stuttering, etc. could likely result from the catatonic-fear reaction state exhibited by some patients with PTSD, which interestingly mirrors many of the motor symptoms of Parkinson’s disease—muscle rigidity, akinesia, episodic freezing of movement, stereotyped repetitive movements, and “pill rolling” resting tremor. These motor symptoms are exacerbated by stress and are the consequence of the chronically low levels of dopamine caused by conditions of prolonged and excessive stress. These PTSD symptoms begin with an initial reaction to fear or emotional arousal that increases dopamine production, enabling the amygdala-striatal-supplementary motor area axis to select appropriate life-preserving movements. But with continued or excessive stress, significant alterations in dopamine turnover occur in the amygdala, medial frontal lobes, and supplementary motor area, disrupting an emotional-motor feedback loop and creating amygdala and striatal hyperactivity, which are interestingly the same areas associated with Parkinson’s disease. Boxers and football players who are constantly experiencing head trauma are much more likely to develop Parkinson’s later in life, so there may be some connection to traumatic brain injury and those motor symptoms, which could have been common in World War I (possibly due the lack of technology to protect the head properly?)

Apryl,

Does one's vulnerability to PTSD correlate with cultural factors? For example, would the average member of IS (ISIL) be as vulnerable to this anxiety disorder as the average British or American soldier? I am referring to the core culture and military culture of a nation, tribe or other social group.

Val Belfiglio

Vulnerability to PTSD absolutely correlates with cultural factors. Trauma is an integral part of the human experience, regardless of culture, but the way in which a culture views and responds to trauma certainly influences how people recover (or don’t) from trauma. For example, women belonging to cultures who view rape as damaging to one’s worth or “holiness and cleanliness” are much more likely to suffer PTSD compared to cultures who place the sole blame on the rapist (unfortunately, those cultures are rare). People in cultures who view death as a passage into another life are much less likely to be traumatized by the death of a loved one compared to cultures who view death as merely the end of life. People in cultures who engage in collective grieving and group yoga/meditation/musical practices are also much less likely to develop PTSD after trauma. Social/emotional support is the single most influential risk factor for developing PTSD. I think part of the reason PTSD has been described by some as a “Western phenomenon” is that the Western notion that emotions equate weakness and the pull-yourself-up-by-your-own-bootstraps ideology does not facilitate recovery from trauma.

Now in certain parts of the world that are under constant war/trauma, such as in the Middle East, PTSD-like responses are probably adaptive. When American soldiers are in the middle of combat, their hypervigilance, aggression, etc. are actually life-preserving—it’s when they get home to non-war conditions that it really becomes a disorder. If members of ISIL left the wartime environment of the Middle East to a peaceful state, they probably would have just as hard of a time integrating back into “normal” life as American soldiers do.

The military culture itself does influence risk for PTSD. ISIL members generally have very strong culturally influenced convictions for why they are fighting—their wars are absolutely justified and necessary within their minds and within their group, and thus, they may be less likely to feel the guilt and shame that many American soldiers experience who went to war against their own will (i.e. those who were drafted) or who don’t understand or agree with the wars we are fighting.

I’ve attached a couple papers that may also address your question.

Good question.  I am interested in similar distinctions among cultures regarding violence and aggression.  Honor killings of females are difficult to comprehend using our cultural values and suggest that the feelings of fathers and brothers towards the females in  their families are quite different in thiose cultures that accept honor killing.  Aborting female babies or killing of female babies in Asian cultures seems similar to the killing of babies in Sparta.  You might also want to look into the writings about lynching in America.  The accepted plundering  of conquered cities in ancient wars suggests a quite different emotional formulation of what would constitute PTSD,  The slaughter was face-to-face.

Dear Seth and Apryl,

Thank you both for your  thoughtful comments.  I believe that the correlation between culture and vulnerability to PTSD is frequently overlooked by scholars. If any members of researchgate are psychiatrists or clinical psychologists, your comments would be a valuable contribution to this discussion.

I served 20 years. Military forces are microcosms of societies and cultures they iriginate.  I recommend several no-cost sources of research. The RAND Corporation has did several contracts for DoD. https://rand.org/ and National Academic Press  < https://nap.edu > has a number of publications. You need an account - it's free to download PDF copies.

Best wishes, Peggy

Any mental health issue should be placed within the context of the culture.  Communicating with the deceased, for example, is regarded as a plus in some cultures.  The following is interesting:  https://www.psychologytoday.com/blog/the-human-beast/201209/voodoo-death-i

In my humble opinion, when a culture values veterans and the sacrifices they make in the name of the country's wars, the veterans affected by such service are likely to take full advantage (if qualified) of financial and other programs of support offered by the country.  Most recently, concerted efforts by the US Military to detect, diagnose, and treat PTSD (often complicated by comorbid TBI and /or other injuries) has enabled many who experienced post traumatic stress during their wartime service to get evaluated for PTSD, and claim benefits, if eligible. To ensure apples-to-apples comparison to the PTSD incidence and prevalence in Roman Soldiers, I recommend you limit your study of contemporary veterans to only those who actually deployed to and engaged in combat operations. I believe modern America provides rich benefits to support service-member/veteran care and disability payments, and imposes federal mandates to perform annual (or more frequent, if deployed) screenings to evaluate veterans for PTSD and other service-related injuries,  whether they've deployed or not, and whether or not the traumatic stress event(s) came from combat or other stressful military or domestic environments.  Such incentives/benefits enable a country to recruit and sustain a ready military force by giving its members peace of mind that they will be taken care of if injured in line-of-duty (for both visible and invisible wounds). If that is how you are defining "culture" then you will be introducing new, and important insights that have been overlooked in the past.  I look forward to reading your results!

Ellen,

Your point about limiting my study to modern soldiers engaged in combat operations is well taken. My problem is I want a cross-cultural comparison. I don't think it is possible to gather accurate and reliable data about ISIS. al-Qaeda  or other current  American enemies. Any suggestions? I chose the Romans because ancient physicians such as Galen and Celsus documented their findings.

Dear Val,

For an interesting and thought-provoking publication on trauma and warfare in antiquity and which influence culture may have had on the soldier's mental wellbeing, I suggest the research done by Jason Crowley (J. Crowley, The Psychology of the  Athenian Hoplite: The Culture of Combat in Classical Athens (Cambridge 2012)), and more recently his contribution "Beyond the Universal Soldier: Combat Trauma in Classical Antiquity" in which he compares the differences in culture and experience of US veterans and Athenian hoplites. For a convenient overview of the debate of PTSD in antiquity, I also recommend the article in Ancient Warfare "PTSD in Ancient Greece: Was there mental trauma in Ancient Warfare?" which is uploaded on the Academia website: https://www.academia.edu/34616778/PTSD_in_Ancient_Greece_Was_there_mental_trauma_in_Ancient_Warfare

For a Roman viewpoint on war traumas, I wrote a paper "The recognition of Roman soldiers' mental impairment": Article The recognition of roman soldiers' mental impairment

All the best,

Korneel