When we talk about PTSD (Post Traumatic Stress Disorder) among soldiers, we often generalize the experience across different armies and countries. However, the reality is far more complex. In this post, we will compare the experience and outcomes among American and Israeli soldiers.
Despite facing similarly traumatic experiences, American and Israeli soldiers report significantly different rates of PTSD. This discrepancy isn't just a matter of methodology and numbers; it’s rooted in profound differences in military culture, societal support, and even the very way PTSD is diagnosed and treated.
A Shared Burden
In the United States, PTSD among veterans is alarmingly common. Depending on the conflict, between 11% and 23% of U.S. veterans experience PTSD within a given year, with rates being as high as 30% among Vietnam War veterans. For many American veterans, the symptoms of PTSD are severe and debilitating, leading to challenges in their personal and professional lives, including unemployment, homelessness, addiction, and a higher risk of suicide.
On the other hand, the reported rates of PTSD among Israeli soldiers are lower. A 2013 study by the Israeli Defense Forces (IDF) Medical Corps revealed that 8% of soldiers deployed to high-combat zones met the clinical criteria for PTSD after deployment. In the most recent Israel-Hamas conflict, around 1,600 IDF soldiers have shown symptoms of combat-related PTSD, but the majority received timely intervention and were able to return to their duties.
This difference raises an important question: what is it about Israeli society and military culture that mitigates the impact of PTSD?
Universal Military Service
One significant factor is the nature of military service itself. In Israel, military service is mandatory for nearly all citizens. This creates a culture where being a soldier is a universal experience, shared by the entire population. The societal understanding and support for soldiers and veterans are deeply ingrained.
American soldiers, who volunteer for service, often return to civilian lives where their experiences are not understood or shared by those around them, leading to feelings of isolation. U.S. Senator John Kerry, who was also a Vietnam War veteran said in 1971, during his testimony before the Senate Foreign Relations Committee:
“Most people didn’t even care about the war. We came back and found not only a lack of support but a profound sense of disconnection.”
This social alienation can exacerbate PTSD symptoms, making it harder for American veterans to reintegrate into civilian life.
The Proximity of Conflict
Israeli soldiers often fight in close proximity to their homes, and the threats they face are existential. "The collective responsibility for national defense creates a unique environment where soldiers feel a profound connection to their mission. For Israeli soldiers, the connection between their military actions and the safety of their families and country is immediate,” explains Prof. Eyal Fruchter, former Head of Mental Health of the IDF and Director of Medical and Scientific Affairs at ICAR Collective. This clear sense of purpose can provide a psychological buffer against the worst effects of trauma, as soldiers understand the critical importance of their actions.
In contrast, American soldiers are frequently deployed thousands of miles away from home, in conflicts that may seem distant and disconnected from their daily lives. The dissonance between their experiences abroad and the reality they return to can contribute to the development of PTSD as they struggle to reconcile their actions with a civilian life that seems untouched by the wars they fought.
Community Support
The way soldiers are treated upon their return from service also plays a crucial role in their mental health. In Israel, veterans are generally welcomed back as heroes and are reintegrated into a society that understands and honors their sacrifices. There is a robust network of support for returning soldiers, including mental health services that are integrated into the military from the outset. This ongoing support helps prevent the isolation that many American veterans face when they return home.
“That lack of understanding also feeds into the stigma associated with mental health challenges such as PTSD, which can deter people from seeking care,” says Cohen Veterans Network President and CEO Dr. Anthony Hassan. The stigma associated with mental health issues often discourages them from seeking help, and without adequate support, they can find themselves struggling with unemployment, homelessness, and a lack of purpose. This lack of societal reintegration and support exacerbates the mental health challenges they face.
A Spectrum Approach to PTSD Diagnosis
One of the most significant differences between how PTSD is handled in the U.S. and Israel lies in the diagnosis. In the U.S., PTSD is typically diagnosed in a binary way—you either have it, or you don’t. This approach can leave many veterans without access to the care they need, as those who don’t meet the full criteria for a PTSD diagnosis might still suffer from significant symptoms but are ineligible for certain benefits and treatments.
In Israel, PTSD is seen more as a spectrum. Israeli soldiers with PTSD symptoms are often not labeled as "handicapped" or disabled. This avoids the stigma associated with such labels and encourages soldiers to continue engaging in work and social activities. By viewing PTSD as a condition with varying degrees of severity, Israeli veterans are more likely to stay active in the workforce and maintain a sense of purpose, which is crucial for their mental health.
“American psychiatry is also moving in the direction of a spectrum approach, recognizing the overlap of symptoms among a range of disorders as biological mechanisms of these conditions are identified”, reports Dr. David Silbersweig, Chairman Emeritus of Psychiatry at Brigham and Women’s Hospital/Harvard Medical School.
Conclusion
The differences in how PTSD is experienced and managed by American and Israeli soldiers offer valuable lessons. The American system could benefit from adopting some aspects of the Israeli approach, such as viewing PTSD on a spectrum rather than a binary condition, and ensuring that returning soldiers receive strong societal support to help them reintegrate. This could potentially reduce the long-term social and economic costs associated with PTSD and improve the quality of life for American veterans.
Addressing these differences is not just about improving mental health outcomes; it’s about honoring the sacrifices that soldiers make by ensuring they have the support they need to thrive after their service. As we continue to learn from different approaches around the world, the hope is that all soldiers, regardless of where they serve, can receive the care and support they deserve.