Jones et al (Reference Jones, Vermaas and McCartney2003) draw conclusions that I believe are not entirely supported by the results of their study. The results show us that the percentage of flashbacks in post-combat syndromes is as low as 9%, thus challenging the credibility of flashbacks as a diagnostic sign for PTSD. Moreover, the study showed that only 9% of the soldiers with combat syndrome exhibit flashbacks.

The argument that PTSD is a culture-bound syndrome is quite overstated. It seems that somatic symptoms are far more widespread in PTSD than are flashbacks. These somatic symptoms stand at the base of traumatic syndromes. The link between PTSD and culture is weaker than we might think. Elbert & Schauer (Reference Elbert and Schauer2002) state that survivors from different cultures (Sudan and Somalia) exhibit psychiatric symptoms of PTSD. Jones et al (Reference Jones, Vermaas and McCartney2003) state that many historical documents regarding trauma lack a common denominator, and they are right to some extent. However, I have shown (Reference Ben-Ezra2001, Reference Ben-Ezra2002) that the somatic symptoms of nightmares, sleep disturbances and increased anxiety occurring as a response to traumatic events are symptoms that have not changed in 4000 years. There is some connection between trauma and culture, but this connection is mild at most. I do agree with Jones et al that PTSD is an evolving syndrome. In my opinion, the core of PTSD (somatic symptoms) is timeless and not culture-bound. However, other less-common symptoms are prone to some cultural influence.