The Social Construction of Mental Illness

The Independent starts with this puzzling fact:

“Something is happening at the end of the wars in Iraq and Afghanistan that mental health experts are finding hard to explain: British and American soldiers appear to be having markedly different reactions to the stress of combat. In America, there has been a sharp increase in the number experiencing mental-health problems, including post-traumatic stress disorder (PTSD). Between 2006 and 2007 alone, there was a 50 per cent jump in cases of combat stress among soldiers and suicides more than doubled. Why the precipitous rise? And why hasn’t there been an accompanying rise in these symptoms among British troops?

The conclusion that British soldiers appear to have a different psychological reaction to the stresses of these modern conflicts was the finding of several recent high-profile studies. This year, in a Royal Society journal, Neil Greenberg of the Academic Centre for Defence Mental Health at King’s College London and colleagues reported that studies of American soldiers showed PTSD prevalence rates of in excess of 30 per cent while the rates among British troops was only four per cent. UK soldiers were more likely to abuse alcohol (13 per cent reported doing so) or experience more common mental disorders such as depression (20 per cent).

Such differences were found even when comparing soldiers who served in the most intense combat zones. In addition, while researchers found increased mental-health risk for American personnel sent on multiple deployments, no such connection was found in British soldiers.”

So, yes, it is not a bad idea to look for sociological explanations for this if indeed, combat conditions and numbers of deployment were controlled for. In other words, the idea is that social structure, power dynamics and culture create a context in which certain categories of thought emerge.

This is the social construction of reality. This is also something that Foucault studied in Madness and Civilization: how a society perceives certain behavior sand classifies them has less to do with the behaviors themselves (see how much the supposedly scientific and objective DSM has changed over the years), but with genealogies of power. In Western societies, the medical practitioner displaced the priest as the adjudicator of proper behavior and moral authority to decide as to what is mentally healthy and what is not. The many ways in which mental health is defined, diagnosed and treated has a lot to do with social control and normative enforcement.

So, again, what social conditions and dynamics would generate the differential rate of PTSD between American and British soldiers? The article goes over some of the history of dealing with soldiers coming home with mental problems and how the rise of the PTSD diagnosis had a lot to do with the US context of the Vietnam War and the social movement opposing it. The diagnosis then became more mainstream and embedded into the language of post-combat mental problems. This context is specifically American, and therefore less likely to affect British soldiers.

It is interesting but then comes the inevitable BS:

“Patrick Bracken, of Bradford University’s Dept of Health Studies, argues that the emergence of PTSD is a symptom of a troubled postmodern world. “In most Western societies there has been a move away from religious and other belief systems which offered individuals stable pathways through life, and meaningful frameworks with which to encounter suffering and death,” Bracken writes. “The meaningful connections of the social world are rendered fragile.”

Oh please. Not only is the American society drowning in religion and conservative dominant discourse on war and the role of the military but the US military is awash in fundamentalist and evangelical Christianity. If the statement above were true, then the British soldiers would the ones suffering from higher levels of PTSD, not the other way around.

So, maybe we should examine more seriously how fundamentalist religion might affect returning soldiers. Or the social conditions of their reinsertion (or lack thereof) in combination with the differences in health care systems between British and American soldiers.

Here is another suggestion: look at the demographics of the soldiers. We know the US military taps into the lower classes since the military is pretty much the only potential source of social mobility. Is it the same for the UK? And, of course, the process leading to the diagnosis themselves would need to be examined.

Unfortunately, the statement above explains nothing and provides no evidence of anything beyond this person’s ability to spit out a tired cliché. So, why is it even in the goddamn article?

Or have the awful, awful feminists made American soldiers wimpy? </sarcasm>

5 thoughts on “The Social Construction of Mental Illness

  1. I wonder if the original researcher had any knowledge of the administrative and political context in which US and UK soldiers respectively came to Iraq and Afghanistan?

    News reports in the US have informed the American public that many if not most of the troops in both conflicts are reservists and not career soldiers. Many of them were deployed repeatedly, had their deployments extended seemingly at whim, and were subject to (illegal) dismissal from civilian employment and in some cases, home foreclosure (of course, when the latter was revealed in the press, the bank in question was forced to apologize and make things right, but the damage had already been done).

    Add to that the deplorable condition of US military medicine (stateside as opposed to in-country; the Walter Reed hospital scandal is a major example) and a command structure that sent physically and mentally wounded soldiers back into action prematurely, and you have a recipe for disaster. This has manifested itself in a number of shocking crimes in the areas surrounding military facilities in the States, one occurring just this week as a soldier living near Joint Base Lewis-McChord apparently murdered his five-year-old son and then his wife before taking his own life.

    I suspect the Brits treated their troops with more regard than our government, for all its patriotic blather, is capable of doing.

    • I think they did control for length of deployment / number of deployment.

      Regarding economic hardship, this would certainly be detrimental to anyone’s mental health, but this is not the same as PTSD.

      You’re right on the medical care issue. I actually remember reading about the reluctance to diagnose soldiers with mental health conditions so as to avoid having to care for them. And wasn’t Fort Bragg domestic violence ground zero a few years back? Clearly, the US military does not deal well with the mental issue of its soldiers.

  2. My sense is that the likely reasons for the disparity will centre on two things:

    a. British troops do 6-month tours, US troops 12-14 months
    b. British units are very cohesive – it’s not unusual for infantry to serve their entire 22-year career in the same battalion, perhaps even the same company, returning to the ‘home’ unit after detachments and secondments.

    I think it’s probably not that accurate to say that the US Army taps into the lower classes – combat troops in my experience tend to be folk looking for a bit of adventure and perhaps some GI Bill benefits. Middle-class types with high school and perhaps even some college are, if anything, over-represented in, say, the Rangers, airborne forces or the Special Forces. Lower-class folk will tend to enlist in technical and service fields where they can get an education, which their circumstances may have caused them to miss and a secure environment – three hots and a cot, if you like.

      • The National Guard is an interesting and complex organisation, of course and the remarks about the Guard in the South might not apply equally to, say, the NY or California Guard.

        Having served over 25 years in the British Army, myself and having worked a lot with my US comrades, the single biggest difference between the organisations, to my mind, is that the British Army is a professional institution with a long mercenary tradition and in many ways recalls Wellington’s Army, rather than the mass armies of the First and Second Wars. There’s *none* of the religious or patriotic tone which is often found in the US forces and the nation as a whole does not see itself (as does the US) as being at war. In the last 200 years, the only year in which no British soldier has been killed on active service was 1968, so we have a lot of form for small-scale conflicts ongoing – an inevitable result of the retreat from Empire.

        What this means is that the guys in the ranks aren’t routinely bullied and hectored to aspire to any particular higher standards other than to comply with the internationally agreed Law of Armed Conflict, the Army Act (which is the corpus of military law) and the UK Common Law. There is an acceptance that soldiers are not necessarily terribly nice people, an understanding that their preferred relaxation will often involve alcohol, members of the opposite (or same) gender and, not infrequently, fist fights. There is an equal understanding from the side of the soldier that he will be punished, quite severely, if he ‘takes the piss’ – i.e. oversteps the mark. Young officers and their senior NCOs spend quite a lot of time keeping their guys out of trouble!

        Now, this way works for the Brits as long as the guys and girls are in uniform. It does get a bit wobbly after discharge, though and it is alarming just how many homeless folk or prison inmates are former Service personnel. With PTSD taking up to 20 or more years to manifest itself, there is a concern, as well, at whether or not a bulge is going to come in the 2010s from the long campaigns in Iraq and Afghanistan.

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