The Brooksy Awards 2015. II

Greek dancing and tumbling, via THE DANCE: Historic Illustrations of Dancing from 3300 B.C. to 1911 A.D., BY AN ANTIQUARY, London, 1911.

So Brooks is pleased by Sebastian Junger's article from last May in Vanity Fair, which

starts by stating the American military has the highest post-traumatic stress disorder rate in its history, and probably the world. But then he notes there is no statistical relationship between suicide and combat. Vets who worked far from the violence are just as likely to commit suicide. Over the decades, combat deaths have dropped while PTSD rates have risen. The Israeli Army, which sees a lot of trauma, has a rate as low as 1 percent.

Obviously, to Brooks, that's a sign of our "lack of community" here in the selfish every-man-for-himself States, unlike that warm, loving, united Israel where there's no alienation because everybody's just so totally committed to togetherness, though what Junger was interested in is naturally something else, that is the effectiveness of the IDF in dealing with traumatic stress in a way the US fails to do, through a swift forward treatment (of the kind, as it happens, pioneered by the Wehrmacht in World War II:

soldiers who had suffered acute combat stress (such as being buried under a bunker hit by a bomb) were given some form of psychological assistance soon after rescue; they were typically sent to a forward area first aid station (Verbandsplatz) where they received milk and chocolate and were allowed to rest

just as Israeli soldiers get to go home for Shabbat every two weeks, which would have been pretty tough logistically for Americans in Iraq. Just saying.)

I typically got stuck on that "as low as 1 percent", though, What does that mean? It gets down to 1% at certain pleasant times of year, or at generational lulls sometime between 1948 and now? Junger himself doesn't help a whole lot with his own wording, and failure to cite a source:

Even the Israeli military—with mandatory national service and two generations of intermittent warfare—has by some measures a PTSD rate as low as 1 percent.

Ah, by some measure—which? And what kind of measures? The closest I can come to 1% Googling around is a number from Sheldon Adelson's Israel HaYom, referring only to veterans of the 34-day attack on Hezbollah forces in Lebanon, 2006, and counts only on the basis of those who sought treatment, and is higher than that too:

According to the study, 1.5 percent of Israeli soldiers in mandatory service and in the reserves were diagnosed with PTSD after the 2006 Second Lebanon War. Some 2.9% of the servicemen who took part in the military campaign sought psychological help after the war, but were not diagnosed as suffering from PTSD....

The Medical Corps did, however, qualify its findings, saying that in all likelihood many soldiers who suffer from PTSD do not seek medical attention.

PTSD diagnoses in other militaries worldwide ranged from 2% to 17% of troops who participated in combat, the IDF study said. A recent study by the U.S. Army Medical Corps found that about 8% of U.S. soldiers who served in Iraq and Afghanistan had been diagnosed as suffering from PTSD.

That's not a rate, it's a score. Assuming all these numbers have an actual source, Israel's 34-day war racked up about a third as many diagnosed cases, proportionately, as did the all the six-month combat deployments, one, two, and more per person, of the US ten-year wars. That's pretty concentrated. And then another study found "less than five percent" PTSD sufferers from the Second Lebanon war and 49-day 2014 Gaza incursion put together, which would be a good deal more concentrated still.

But it's a fact that many sufferers don't seek medical attention, not an "in all likelihood", so we don't have any real knowledge of how many those are, or how they differ from war to war; for the best kind of evidence you need a survey study of a sample including people who haven't gone to the doctor and don't think they have symptoms. Thus for the US, an agglomeration of extensive studies back in 2009 found rates of 12% for Afghanistan and 18% for Iraq, with rather higher rates for reservists and National Guard members. You can assume that the actual traumatic stress rate for IDF soldiers is similarly greater than the number of diagnoses.

No study of that exact kind seems to have been done for Israel, though, or if it has it hasn't been publicized; but an outreach effort to the front-of-the-front in the Gaza conflict found some large fraction of 70%:

Israel Defense Forces' (IDF) Col. Dr. Keren Ginat, who is head of the army's mental health services, told a ministerial oversight committee on Monday that the IDF had invited 1,000 soldiers known to have been wounded in combat or involved in intense firefights in Gaza to come in and talk to bosses about their experiences.

Some 70% of the soldiers scored highly on the PTSD checklist and have been referred for additional treatment, Ginat said.

That's really a lot, But we don't know what is represented by the thousand soldiers under study (possibly 100% of the most deeply engaged in the fighting; it could easily have included 100% of the wounded, since there were only 469 total Israeli soldiers wounded in the whole operation), so we don't know what it says about the army overall, or the much smaller number that saw combat last summer, and it quite likely says nothing, just as the doubled number of IDF suicides last year isn't indicative of anything, unless it is.

On the other hand, studies of the more reputable type have been done for the Israeli population as a whole, and they get a picture in which Israel seems worse off than other countries

The Israel Center for the Treatment of Psychotrauma (ICTP) has been active since 1989 as a project of the Herzog Hospital Latner Institute to contend with the growing phenomenon of psychotrauma in Israel, where an estimated 9% of Israelis suffer from Post Traumatic Stress Disorder (PTSD), three times the level of that in the US and other western countries.

Usually when we see a number of this type for the Israeli population it's in the context of a different type of propaganda, focusing on the stress Jews in Israel are placed under by the hostility of the surrounding Arab populations in Lebanon and the occupied Palestinian territories—by their fear of rockets and sudden knifing. But in this context of discussing PTSD among the Israeli military, it puts me in mind of another thing Junger is actually talking about, as opposed to Israel's great sense of community: the paradox of how the incidence of PTSD seems to have some kind of inverse relationship to the soldier's closeness to combat:

During the 1973 Yom Kippur War, when Israel was invaded simultaneously by Egypt and Syria, rear-base troops in the Israeli military had psychological breakdowns at three times the rate of elite frontline troops, relative to their casualties. And during the air campaign of the first Gulf War, more than 80 percent of psychiatric casualties in the U.S. Army’s VII Corps came from support units that took almost no incoming fire, according to a 1992 study on Army stress casualties.

In Israel's state of continuous low-grade war the civilian Jewish population is really part of the total mobilization, and plays the role of the rear-base troops or support units in being afflicted worst by traumatic stress.

Because it isn't fear of rockets or stabbing that causes combat stress disorders! As Junker goes on to say,

In a survey done after the first Gulf War by David Marlowe, an expert in stress-related disorders working with the Department of Defense, combat veterans reported that killing an enemy soldier—or even witnessing one getting killed—was more distressing than being wounded oneself.... [and] Many soldiers go through horrific experiences but fare better than others who experienced danger only briefly, or not at all. Unmanned-drone pilots, for instance—who watch their missiles kill human beings by remote camera—have been calculated as having the same PTSD rates as pilots who fly actual combat missions in war zones, according to a 2013 analysis published in the Medical Surveillance Monthly Report. 

(I've written about that drone pilot thing before.) Or as world-famous traumatic stress expert David Brooks once wrote (back last February),

The victims of PTSD often feel morally tainted by their experiences, unable to recover confidence in their own goodness, trapped in a sort of spiritual solitary confinement, looking back at the rest of the world from beyond the barrier of what happened.

The terrible PTSD rates of US forces in the Afghanistan and Iraq wars were brought on by the soldiers' and marines' knowledge, however they concealed it from themselves (and perhaps to a great extent because they concealed it so that it festered like a wound under a bandage that doesn't get changed regularly), of the terrible and unnecessary character of the project they were engaged in. And in Israel, the farther out of danger ordinary citizens are, the more they are haunted, even in their strenuous denial, by the wrongs their society is inflicting on others, and it's making them sick.