Really fascinating article on Post-Traumatic Stress Disorder in Vanity Fair by Sebastian Junger, which questions much of the generally accepted wisdom about this mysterious, inconsistent war wound.

Just a few of Junger’s ideas: For the most part, military members, even those who’ve seen combat, don’t seem to experience higher suicide rates than the general public. Soldiers who kill remotely via drone are just as likely to suffer trauma as their counterparts who kill at close range. Those who experience no combat often have higher levels of PTSD than those who see heavy combat. Just puzzling. Elite soldiers rarely experience such troubles, perhaps because they’ve reached that status thanks in part to possessing high levels of a particular amino acid which acts as a natural buffer against stress. And the questions are obviously thorny regarding soldiers receiving permanent disability for what often doesn’t need be permanently disabling.

An excerpt:

Suicide by combat veterans is often seen as an extreme expression of PTSD, but currently there is no statistical relationship between suicide and combat, according to a study published in April in the Journal of the American Medical Association Psychiatry. Combat veterans are no more likely to kill themselves than veterans who were never under fire. The much-discussed estimated figure of 22 vets a day committing suicide is deceptive: it was only in 2008, for the first time in decades, that the U.S. Army veteran suicide rate, though enormously tragic, surpassed the civilian rate in America. And even so, the majority of veterans who kill themselves are over the age of 50. Generally speaking, the more time that passes after a trauma, the less likely a suicide is to have anything to do with it, according to many studies. Among younger vets, deployment to Iraq or Afghanistan lowers the incidence of suicide because soldiers with obvious mental-health issues are less likely to be deployed with their units, according to an analysis published in Annals of Epidemiology in 2015. The most accurate predictor of post-deployment suicide, as it turns out, isn’t combat or repeated deployments or losing a buddy but suicide attempts before deployment. The single most effective action the U.S. military could take to reduce veteran suicide would be to screen for pre-existing mental disorders.

It seems intuitively obvious that combat is connected to psychological trauma, but the relationship is a complicated one. 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. And even among regular infantry, danger and psychological breakdown during combat are not necessarily connected. 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.•