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Military Suicide and Military Families: Part 2

In my last post I sought to bring attention to an overlooked aspect of the current tragedy of military suicide – suicide within military families.  While hard statistics are unavailable at this time, anecdotal evidence indicates elevated levels of suicides and suicide attempts by military spouses, due to high levels of stress and secondary trauma.

I quoted two military wives – Ms. Deborah Mullen, wife of former Chairman of the Joint Chiefs of Staff and retired Navy Admiral Mike Mullen, and Kristy Kaufmann, wife of an Army soldier and executive director of the Code of Support Foundation – as they eloquently spoke out about this troubling issue.  Deborah pointed out that stigma still exists against military spouses admitting their mental health challenges and post-traumatic stress.  Depression, anxiety, sleeplessness, panic attacks, and self-medication with alcohol and drugs have become a part of military spouses’ lives, as well as the lives of their active duty and veteran partners.

I ended my last post with the question: What happens for the desperate spouses who do gather the courage to seek treatment within the Department of Defense and Veterans Affairs mental health services?  I draw my information here directly from Ms. Mullen’s address to the 2011 Military Health System Annual Conference.

 

The experience of spouses who seek help is “disappointing”, Deborah states.  “Misdiagnosis.  Lengthy waiting periods.  Red tape.”  Obstacles that “discourage and indeed damage the healing process”.

At the same military post hospital, she reveals, two spouses who sought treatment for help with classic PTS symptoms – one with suicidal thoughts – were prescribed five and seven medications each, with no followup appointments.  And, “Neither was ever referred for psychological help.”

I’m going to make a very strong statement here.  I believe a system that would allow a general practitioner to prescribe multiple, heavy-duty medications for psychological symptoms and then not see the patient again, is broken.  This is especially true for patients with suicidal thoughts.  Several prescription anti-depressants have been recently shown to create or intensify suicidal thought ideation.  I believe the actions of the doctors at this post hospital were unethical and unconscionable.

But there is even more going wrong for suffering military spouses within the mental health approach of the DoD and VA.  According to Ms. Mullen, spouses refer to it as the “15 and one rule”.

“It goes like this,” she explains.  “No matter WHAT may be bothering you from a health perspective, you are allowed to discuss only one symptom and only then for 15 minutes.  That’s it, no exceptions.  If we accept, as we have, that spouses suffer a PTS all their own . . . and if we know, as we do, that PTS manifests itself in many different ways in many different people, why would we not accept the need to treat the whole person?  Why would we fail to look at the totality of issues confronting a young spouse?  And why would we ask that young spouse not to confront them all herself?”

As a professional in the mental health field, with over 40 years of experience, I’m appalled and angry at what I see as insensitive and unprofessional practice within the military health system.  Patients must have the time and opportunity to reveal an accurate picture of the issues they face and the symptoms they experience.  With suicide as a potential outcome for desperate patients, I would characterize the treatment protocols for military spouses as very irresponsible and dangerous.

Kristy Kaufmann has strong words of her own on an additional obstacle.  “The fact is,” she wrote in a New York Times opinion piece last fall, “even if everything in the Pentagon and the VA were working perfectly, the government simply does not have the resources – or culture, for that matter – to support the level of need after 10 years of war, and it never will.”

Are you angry yet?

Combat and active duty experiences create their own patterns of post-traumatic stress for our service members.  What are the special problems that enter the lives of military spouses and families, leaving trauma in their wake?  I will return to answer that question next week.

Military Suicide and Military Families: Part 1

Today I want to return to the topic of military suicide and discuss a different and sadly overlooked side to this tragedy.  Yes, active duty service members and veterans are taking their lives at alarming rates, but suicide within service member and veteran families – among spouses in particular – is happening as well.

Two voices have recently spoken up about this underreported issue.  Deborah Mullen, wife of former Chairman of the Joint Chiefs of Staff and retired Navy Admiral Mike Mullen, delivered an address to the Military Health System Annual Conference in early 2011 on the topic.  Kristy Kaufmann, wife of an Army soldier and executive director of the Code of Support Foundation (a nonprofit organization dedicated to bridging the gap between civilians and military America), published an opinion in the New York Times last November.

Both Deborah and Kristy point out that we have no accurate accounting of rates of spousal suicides within the military, due to privacy rules, and that this in itself is part of the problem.  Recent studies of military suicide have excluded the mental health of military family members, “effectively ignoring half of the problem”, Ms. Kaufmann stresses.

Only anecdotal evidence exists on the numbers of suicides and suicide attempts.  “Three Army wives I knew personally all took their own lives,” Kristy writes.  “Suicide attempts and completions among family members occur far more often than many realize or care to acknowledge.”  She adds that “suicide among service members, veterans and families is an indicator of the amount and duration of stress we continue to bear.”

“War comes home,” Kristy eloquently tells us.  “No soldier comes back the same, which means no family is ever the same.”

Deborah Mullen’s revelatory conference speech deserves to be read in its entirety.  She points out that there are many specific programs in place to help spouses with challenges such as the day-to-day demands of being a single parent or being a new caregiver to a wounded veteran.   But, “we are still discovering, still revealing, fissures and cracks in the family support system,” she observes.

The first “fissure” she mentions is “secondary post-traumatic stress”, and I see this as an extremely important and relatively misunderstood phenomenon.  Secondary post-traumatic stress, or secondary trauma, is the stress and trauma we are not directly exposed to but experience through someone else’s eyes and memories.  It is also the pain we feel as we watch someone we care about suffer and change from those first-hand experiences.  Kristy put it well: War comes home.

Suicide is the most extreme and tragic symptom of secondary trauma, but there are plenty of other symptoms as well. Ms. Mullen clearly identifies many of them.  “Families experience depression, anxiety, sleeplessness, and headaches,” she observes, as well as cold sweats, lost concentration, panic attacks, and dread of contact with the outside world.  Many spouses are “unable even to get out of bed, to get dressed, prepare meals, or leave the house.  Some won’t even get their children off to school, leaving the care of little ones in the hands of older siblings.”

“We shouldn’t be surprised,” Ms. Mullen continues, “to learn that some spouses turn to the same remedies that troops with PTS turn to – alcohol, prescription drugs, and some even contemplate suicide.”

The military branches have recognized for some time the stigma attached to mental health issues within the ranks.  Programs have been put in place to address the issue so that more service members can get the care they need and deserve.  But Deborah Mullen points out something I think most people are unaware of: the stigma against military wives seeking help for their own mental health challenges.

First of all, she believes, they’re “embarrassed” to seek help.  They also “worry that in doing so, they could negatively impact a husband’s or wife’s military career.”  As a final straw, “the service member even warns the spouse against getting help.”  “The services have worked hard to reduce mental health stigma in the ranks,” Deborah states, “but we need to continue to work to eliminate it from our homes as well.”

What happens for the desperate spouses who do gather the courage to seek treatment within the Department of Defense and Veterans Affairs mental health services?  Deborah Mullen’s insider assessment paints a bleak, disturbing picture.  I will begin with that distressing portrait when I return next week.

Surprising Findings on Postwar PTSD

A recent op-ed piece in the New York Times by Anthony D. Mancini reported surprising and disturbing preliminary findings from a military PTSD study soon to be published in the British Journal of Psychiatry.  Mancini, an assistant professor of psychology at Pace University, and his colleagues set out to examine the stress responses of over 7000 United States service members, pre- and post-deployment to Iraq and Afghanistan.  The verdict?  “Fewer than 7 percent showed signs of PTSD following deployment”, and “among those with multiple deployments . . . only 4 to 5 percent” suffered from PTSD.

I don’t buy it.  Those numbers are way too low.

While we must wait for the full study to be published before drawing firm conclusions, Mancini’s contention that “the prevalence of PTSD among veterans” is “substantially lower than is commonly believed” should be a cause for concern. 

I want to see how the researchers set up the study, look at the guidelines and approach they used, and examine how they interpreted their data.  Researchers always go into a study with a goal, something they hope to prove, and possibly even additional agendas they are not fully conscious of.  These agendas can color the findings they report.  The study results quoted in Mancini’s piece on the low prevalence of PTSD among returning service members are so counter to what I’ve seen in my work that I suspect some bias crept in.

Mancini states that “many assume that humans are inherently vulnerable to trauma”, but that “a growing body of scientific research is telling another story”.  Only the first part of that statement is true.  Our nature as human beings, our biology and psychology, program us to respond to traumatic events in patterns that ensure our survival.  Almost everyone has heard of the “fight, flight, or freeze” responses, arising from our sympathetic and parasympathetic nervous systems.  These responses to danger make it possible for us to survive and then learn from threatening experiences.

Trauma, short-lived or lasting, arises when we fail to complete our natural trauma response.  Because we can bury and refuse to deal with the painful and overwhelming events of our lives, the intense emotions aroused by trauma (leading to that fight-flight-freeze) may never be released.  This happens all the time.  We can go back and resolve past trauma, but we are always “inherently vulnerable” to it, and our vulnerability to trauma increases the more we bury our previous “invisible wounds”.

The authors of the British Journal of Psychiatry study defend their results by characterizing their respondents as “not seeking treatment” and “representative of the military as a whole”.  They add that “[the participants’] reports were confidential and had no bearing on their military careers”.

I want to make a couple of points here.  First, and most importantly, why didn’t the study include service members who were seeking treatment?  How could the researchers’ study be “representative” without them?

Secondly, confidentiality is certainly an essential factor in getting accurate disclosure, but did the researchers take into account the lingering mindset of stigma within the ranks attached to a diagnosis of PTSD?  Most service branches have campaigns in place to de-stigmatize the invisible wounds of combat, but that message hasn’t yet been fully embraced by the military culture as a whole.

Mancini reports that “about 83 percent of respondents showed a pattern of resilience: they exhibited a normal-range ability to cope with stress both before and after deployment”.  What I want to know is, how did the study’s researchers define “normal-range ability”?  I have first-hand experience with government agencies who work with veterans, and I can absolutely state that their baseline definitions of good coping function are set appallingly low.  Their “good enough” is far from what I consider healthy, as a professional in the psychotherapy field for over 40 years.  I believe the average person would agree with me, and wouldn’t want to see the men and women who have served our country limited to life on such unsatisfactory and unfulfilling terms.

I am particularly suspicious – convinced, even – that the study’s parameters or methods were flawed due to their finding that service member resilience went up with multiple deployments.  This is absolutely counter to everything I’ve witnessed in my work and what many other professionals in my field have seen as well.

I also “do not want to stigmatize those with the disorder” of PTSD, as Mancini cautions.  But I also don’t want to minimize or mislead the military or the public about the true dimensions of what I and many of my colleagues believe will be a hidden epidemic.  I give Mancini credit for stressing that “even an estimate of 1 in 10 represents a public health issue of the first magnitude, requiring our full attention and resources”.  How much more, then, will be required if the real prevalence of PTSD is closer to 30 percent, which is my opinion?

Mancini closes his piece with a truly alarming statement.  He starts well by saying that “PTSD is a treatable condition and a realistic and informed understanding of our inherent coping abilities can only assist treatment”.  But he goes on to propose that “perhaps one day, even prevention of this debilitating disorder” will be possible.  That Mancini could make such a proposal betrays a profound misunderstanding of the nature of human beings and our innate, invaluable trauma response.

To prevent PTSD we would have to rid the world of cruelty, abuse, violence, and evil.  Or we would have to develop into one of two kinds of people: impervious automatons, able to turn off our feelings at will; or psychological super-humans, able to easily experience and quickly and completely resolve every shock, crisis, and horror, from the cradle to the grave.

My take on this?  Won’t happen anytime soon.

Military Suicide and Unemployment

Many factors contribute to the current unacceptably high rates of military suicide.  I’ve written before about a recent policy brief by Dr. Margaret Harrell and Nancy Berglass of the Center for a New American Security, “Losing the Battle: The Challenge of Military Suicide”, which identifies several causes and recommendations for this unfolding tragedy.  Combat injuries, including such invisible wounds as PTSD and traumatic brain injury; mental health issues such as depression and anxiety; other symptoms of trauma such as sleep disturbances, substance abuse and addiction, and high-risk, adrenaline-fueling behaviors – all can play a role.  Harrell and Berglass also observe that the relative absence of three protective factors – belongingness, usefulness, and an aversion to pain or death – are crucial predictors of a service member or veteran’s likelihood of succumbing to suicidal tendencies.

In a New York Times op-ed piece responding to Harrell and Berglass’ study, Peter D. Kramer, a clinical professor of psychiatry at Brown University, proposes another factor overlooked in the policy brief: relatively high unemployment rates among young veterans of Iraq and Afghanistan.  In “The Best Medicine Just Might Be a Job”, he cites an astronomical unemployment rate of 28 percent for male veterans 18 to 24 years old.

Kramer respects the “comprehensive” brief but expresses his concern about the omission of unemployment among the list of causes identified.  While he characterizes himself as “hardly an expert”, he reveals that “study after study correlates unemployment with suicide”.  “When soldiers leave the military,” he continues, “they lose what service provides: purpose, focus, achievement, responsibility and the factor the CNAS report calls ‘belongingness’.  The workplace can be stressful, but especially for the mentally vulnerable, there is no substitute for what jobs offer in the way of structure, support and meaning.”

High unemployment rates among veterans have no one simple cause.  In “As Wars End, Young Veterans Return to Scant Jobs”, Shaila Dewan of the New York Times (who cites unemployment rates for veterans aged 20 to 24 at 30 percent) lists several issues and challenges for both employers and potential veteran employees.  Employers “fear the aftereffects of combat or losing reservists to another deployment”, and veteran job-seekers need to learn basic interview skills while often still “overwhelmed by the transition from combat to civilian life”.

Veterans can be characterized as mature for their age, disciplined, and possessing valuable skills transferable to the marketplace, Dewan emphasizes.  But employers aren’t so sure military service training and experience really translate to civilian industry.

And the competition for jobs is high.  Veterans often serve as reservists or in the National Guard and Dewan points out that this can impose a particularly heavy burden on companies.  Employers of reservists potentially face losing their valuable staff to deployments of up to 12 months in length, while being required to guarantee a job on the reservist’s return.  Even though it is illegal to discriminate in hiring based on military service and status, these requirements can make it nearly impossible for small companies to survive and compete in our difficult economy.

And, in my experience with veterans, both characterizations mentioned above are true.  Former service men and women are more mature and disciplined.  They are skilled, purpose-driven individuals with the kind of values I respect.  But they can also be very troubled individuals, still reeling from their traumatic, combat-related, employment-complicating experiences.  They are often in need of help to work through their lingering psychological invisible wounds.

I assist service members and veterans in this kind of healing.  I hope to do even more when our non-profit, Sonoma Coast Trauma Treatment, begins accepting veterans into its planned comprehensive, case-managed treatment program, which will include providing job-readiness training and skills.  Another promising development to address veteran unemployment is the creation of entrepreneurship programs specifically tailored for vets.

The Wall Street Journal recently reported on several of these programs in “Military Veterans Prepare for a New Role”, by reporter Sarah E. Needleman.  Independent-minded veterans who want to start their own businesses, but lack business start-up know-how, are starting to have a resource in “business accelerators”. Accelerators are programs offering everything from cubicle space and peripherals like Internet and copy/fax services, to expert guidance with business plans, financing, and marketing.

I’m familiar with the business accelerator model.  In my community, my good friend Dr. Michael Newell heads up Sonoma Mountain Business Cluster, an excellent “incubator” program for emerging technology start-ups.  Michael and his team of talented mentors, with the financial backing of local businesses, support aspiring men and women with innovative ideas by providing the best possible opportunity to transform their ideas into jobs and income through facilities, services, and training.  The business school of Sonoma State University also gets involved, helping incubator members create high-quality business plans.  A program of this sort would be an excellent resource for returning veterans in our community and I would love to see one get established.

I recognize the causes and solutions for veteran unemployment are complex.  Nevertheless, I also believe, with Dr. Kramer, that veteran unemployment is a factor we need to consider in addressing our tragedy of military suicide.  We must do a better job of providing employment-related “structure, support, and meaning” for returning vets.  Meaningful work is essential in the process of restoring our service members and veterans, who have sacrificed so much for us, to health and wholeness, and to a place of value in their families and communities.  We owe them nothing less.

Military Suicide: Part 3

The Center for a New American Security recently published an in-depth study of suicide within the United States armed forces.  Losing the Battle: The Challenge of Military Suicide”, by Dr. Margaret C. Harrell and Nancy Berglass, presents an overview, statistics, analysis, and recommendations to help address a growing tragedy – our nation’s combat personnel and veterans are taking their own lives at significantly accelerating rates.  Harrell and Berglass challenge all branches of the military (from top commanders to unit leaders), Congress, and other government agencies to make key and important changes to preserve young American lives.

Last week I presented some statistics and observations from the study; today I will review the authors’ findings and recommendations.  I will also add some observations of my own.

“Losing the Battle” identifies the following as obstacles to reducing military suicides:

1.    Military personnel transfers complicate efforts to help individuals struggling with mental health issues

2.    Army personnel transfers occur too soon after deployment

3.    Commanders are not always aware when subordinates are the subject of an investigation

4.    The mental health screening process following deployment is flawed

5.    A cultural stigma attached to mental health care persists in the armed services

6.    Military hazing persists

7.    The number of care providers is insufficient

8.    Legal restrictions prevent military leaders from discussing privately owned weapons

9.    There is excess prescription medication in the military community

10.  Unit commanders have limited visibility into service members’ medical problems

11.  Infrequent interaction among drilling Guardsmen and Reservists limits unit leaders’ ability to recognize and help subordinates struggling with mental health issues

12.  The National Guard has too many suicide prevention programs

13.  The true number of veterans who die by suicide is unknown

14.  Understanding and addressing the challenge of suicide requires cooperation beyond the traditional jurisdictional boundaries for many organizations, including the Department of Defense, Veterans Affairs, Health and Human Services, and Congress

All these points are important and I have comments I could make on each one.  That would make for an extremely lengthy post, however, so I will limit myself to pointing out what I feel are the crucial issues.  I encourage you to read the entire report for yourself.

Harrell and Berglass’ findings recommend structural, procedural, informational, and cultural changes.  Everything from national government policy, to the intimate conversations between a small unit leader and his troops can be improved.  But I see what I call a “red thread” – a key problem or idea – running through all their observations.

That “red thread”, which has become overwhelmingly evident to me through over forty years of experience in the trauma treatment profession, is the essential understanding that suicide is a symptom of trauma, and that it feeds on secrets and isolation.

Look at the findings.  Each recommendation addresses one of three things.  First, the report addresses the issue of isolation by underscoring the risks of losing connection with struggling service members and veterans through transfers, quick troop dissolution after deployment, and numerous barriers to communication between leaders and individual troops.  Next, the report highlights the destructive nature of secrets, through a culture of shaming personnel for the “weakness” of mental health repercussions from combat service, and through a “don’t-go-there” atmosphere around discussing drugs, personal firearms, and hazing.

Lastly, the report exposes the current limitations of the DoD or VA to address deficiencies in care for emotionally wounded and potentially suicidal personnel, including an insufficient number care providers, inaccurate data-gathering, flawed screening processes, inconsistent prevention programs, and lack of coordination across services and agencies.

Units break up and vital relationships of trust and shared experience are lost.  Admitting to having trouble dealing with emotions and memories will lead to ridicule or negative consequences for military careers.  It’s alarmingly clear that there are too many subjects – besides sexual orientation – for which the message has been “don’t ask, don’t tell”.

Double binds exist.  Commanders and unit leaders want to be able to help their troops, and are prevented from doing so by confidentiality regulations and by cultural taboo.  Revealing the unspoken problems – the secrets service members and veterans won’t tell, so that they can get the help they need with their suicidal thoughts – can create problems for them both in the present and future.

Here’s my message to all our combat troops, past and present: What you can’t, or won’t, talk about – because you’re not supposed to, or no one’s there to listen – can be deadly.  I’ve seen this over and over in my practice.  There is no shame in being affected by horrific events and experiences beyond your ability to handle on your own.  The truth really can set you free.  If you can’t yet tell it within the system, find someone outside the system and break the silence.

Military Suicides: Part 2

Today begins an in-depth look into a study on military suicide recently released by the Center for a New American Security (CNAS).  According to their website, CNAS is an “independent and nonpartisan research institution”, which “develops strong, pragmatic and principled national security and defense policies.”

CNAS is the only Washington think tank led by veterans of the wars in Iraq and Afghanistan.  It has conducted research on military wellness since 2008 because CNAS believes keeping our forces physically and emotionally healthy is vital for national security.  CNAS is also a close partner with Michelle Obama and Jill Biden in their valuable Joining Forces Initiative.

Joining Forces is “a comprehensive national initiative to mobilize all sectors of society to give our service members and their families the opportunities and support they have earned” and focuses on issues of employment, education, and wellness.  As part of the initiative, CNAS hopes to “build and strengthen the network of government agencies, nonprofit organizations, community and philanthropic institutions, businesses and individuals and help them connect in meaningful ways with those who have served.”

That’s a lot of background, but I want you to understand the importance and expertise of this group so committed to our nation’s forces and their families.  Their recent report, “Losing the Battle: The Challenge of Military Suicide”, by Dr. Margaret C. Harrell and Nancy Berglass, tackles our unfolding tragedy head-on, providing accurate statistics and information, as well as recommendations for the future.

Harrell and Berglass reviewed materials from the Departments of Defense and Veterans Affairs, and from independent studies, to gather up-to-date facts and statistics on military suicide.  They reported the numbers I quoted in last week’s post for veteran suicides – including the finding that one veteran takes his life every 80 minutes – but added, “It is impossible, given the paucity of current data, to determine the suicide rate among veterans with any accuracy.”  Then they add the disturbing statistic that although veterans make up only 1 percent of the population, veteran suicides represent 20 percent of all suicides in America.

Harrell and Berglass also researched suicide rates among service members.  Their findings are as alarming for personnel on active duty as for veterans.

1. Between 2005 and 2010, service members took their own lives at a rate of approximately one every 36 hours

2. Army suicides have been rising steadily since 2004, to a record high of 33 deaths in July of 2011 among active and reserve soldiers

3. Marine Corps suicides have increased steadily from 2006, dipping only slightly in 2010

4. Air Force suicides have increased significantly since 2007

5. Soldiers who deploy to Iraq and Afghanistan are more likely to commit suicide than those who do not deploy

6. There are definitive links between suicide and injuries suffered during deployment

7. Traumatic brain injury (TBI) sufferers are 1.5 times more likely to die from suicide

8. Suicide risk among service members is heightened by factors which include chronic pain, post-traumatic stress disorder (PTSD), depression, anxiety, sleep deprivation, substance abuse, and difficulties with anger management

In their report, Harrell and Berglass propose three protective factors that can help a traumatized individual resist the lure of suicide.  They suggest that people who experience both belongingness and usefulness, and have an aversion to pain or death are less likely to take their own life in response to overwhelming emotions or circumstances.  They believe that, in the past, military service included these protective qualities, but now see the changing nature of military service in Iraq and Afghanistan as having actually weakened these three factors.

Military personnel have long felt a strong sense of belonging within their units.  The close-knit camaraderie and team spirit, the code of leaving no one behind, went a long way toward strengthening service members emotionally and psychologically.  Our current wars don’t stick with this pattern, in that units are formed, deployed, and then quickly dissolved after returning from deployment.  Returning Guardsmen and Reservists disband directly back into their communities.  Vital supportive relationships with peers and superiors are lost.

Usefulness in traditional military service included the regular assignment of significant responsibilities and important tasks to relatively junior personnel.  High levels of responsibility and interaction among unit members gave a sense of value and purpose to each member’s contributions.  “In contrast”, Harrell and Berglass report, “the experience of living in a garrison environment or returning to a civilian job, or worse, unemployment, can introduce feelings of uselessness.”  Individual accounts and interviews “show that individuals withdrew, felt disconnected from their units and their families, and perceived themselves as a burden.”  My experience in treating veterans confirms these experiences and perceptions are common and widespread.

Aversion to pain and death – the third protective factor – has always been problematic for military suicide because “military service is one of the few experiences that can override this factor”.  Repeated exposure to the trauma of combat, repeated deployments, witnessing violence and death 24/7 in country in Iraq and Afghanistan, has greatly intensified the traumatic experiences of our military personnel.  To cope and remain effective, many say, they must go numb and consider themselves “already dead”.  This mindset, while it may seem necessary for survival, purposefully and completely erodes any aversion to death.

I’ve taken a lot of space today to share with you the findings of the CNAS report.  I think this information is extremely important and vital for all of us to know.  It disturbs me that the only coverage of this report that I’m aware of occurred in the Huffington Post.  All our local newspapers and media outlets should have reported this.

I agree with CNAS that all aspects of military personnel wellness are vital to our national security.  If you’ve been reading my recent blogs, you know I think it’s also a responsibility and obligation for our government and for each one of us as American citizens.  We must all commit to restoring our returning OEF and OIF forces to health and wholeness.

Next week: vital and on-target recommendations from “Losing the Battle: The Challenge of Military Suicide”.

Military Suicides: Part 1

Today marks the first in a new series of posts about an appalling reality in our culture: the heart-breaking frequency with which United States military personnel are taking their own lives.  What I have to say about this topic will be serious and challenging; the number of recent service member and veteran suicides and suicide attempts should be absolutely unacceptable to every American.  I plan to not only share facts and statistics with you, but also to enlighten you about the underlying causes of this tragic epidemic from my over forty years of experience helping people resolve emotional trauma.

I recognize that this is a heavy subject.  Please stay with me on this one.  I’m going to primarily focus on suicides among combat troops of Iraq (OIF) and Afghanistan (OEF).  I firmly believe this topic must be addressed.  The men and women serving our country in our armed forces deserve to be heard before they use suicide to blast their way to our attention.

First, let me say that suicide attempts and completions are a symptom.  This ultimate act of self-destruction is a symptom of emotional trauma, or what has come to be called “invisible wounds” in our post-9/11 world.  As symptoms, suicide completions and attempts usually happen only after the development of other symptoms or warning signs, such as depression, reckless behavior, or substance abuse.  I’ll go into this later in more detail.  For now, I want you to understand that to effectively treat the symptom of suicide, we’ll need to comprehensibly address and heal our military’s invisible wounds.

The suicide statistics for veterans are truly alarming.  I’m going to start with data from a Department of Veterans Affairs study completed in 2010.  In his article for the Army Times, staff writer Rick Maze reported the following:

  • 18 veterans of all wars and conflicts commit suicide every day (that’s one suicide every 80 minutes)
  • 950 veterans in treatment with the VA attempt suicide every month (that’s 31 suicide attempts per day)
  • 98 veterans of OIF and OEF committed suicide between October 2008 and September 2009 (that’s one suicide every four days)
  • 1,868 OIF/OEF veterans attempted suicide during that same time period (that’s five attempts every day)

Let me tell you why I think these numbers don’t fully represent the magnitude of our veteran suicide problems.

First, this study is limited to information about veteran suicides that the VA knows about.  These statistics cover veterans receiving some type of treatment within the VA system combined with statistics the VA has been able to collect from other sources about veterans outside the system.  The VA’s internal data may be accurate, but many veterans outside the system can “fly under the radar” and their suicides and suicide attempts may not be measureable in any truly precise way.  For this reason, I would bet the VA numbers are low.

Second, I firmly believe that many suicides don’t end up looking like suicides or being reported as suicides.  An example of this that’s been in the news lately is the phenomenon of “suicide by cop”.  In suicide by cop, an individual acts in such a way as to present a flagrant danger to himself or others, in an effort to be shot and killed by peace officers.  Police responding to a scene of domestic violence, or burglary, or assault may find themselves face-to-face with a veteran desperate to end his suffering but unable to complete the act of taking his own life.  The veteran acts in an aggressive, threatening way to the officers, who necessarily shoot in defense of themselves and/or innocent bystanders.

Another example of disguised suicides and suicide attempts are deaths from reckless behavior.  A veteran feeling there’s “no way out” climbs on his motorcycle and speeds past control into a fatal crash on a winding country road.  Another veteran combines prescription medication with alcohol and no one really knows whether he slipped away by mistake or design.  Many incidents like these are masked suicides and not all of them will find their way into our statistics and awareness.

I’ve treated many OIF/OEF veterans and I’ve seen that they don’t want to draw attention to themselves.  When I ask the veterans I’ve been able to help how I can find and reach out to other hurting veterans in the community, they all say, “They don’t want to be found.”  This tells me the magnitude of our veteran suicide problem is probably significantly greater than we know, even with the most careful and conscientious reporting efforts.

What we do know is alarming enough.  Next week, in Part 2 of this series, I’ll present the results of another, recent military suicide report by the Center for a New American Security.

We’ve Got a Bad Connection

This week I want to return to a disturbing statistic, taken from a recent Pew Research Center survey of veterans and the American public, which I quoted in my last post.  Only about half of our civilian population feels that our armed forces’ sacrifices have been greater than their own, post-9/11.  I want to repeat that, as I repeated it last week – only about half.  I think this reveals a bad connection, an enormous disconnect between our veterans and our communities.  Of those civilians who do believe the military and their families shouldered greater burdens with their combat service, about 26% believe it to be unfair, while 70% consider it “just being part of the military”.  I find that attitude very disturbing as well, and I will get back to it later in this post.

First, some good news.  The survey results indicated that 96% of veterans are proud of their service, 93% say the military helped them mature, and 74% say their military experience has helped them get ahead in life.  Over 80% would recommend a military career to a young person close to them.  Also on the positive side, as reported by Tom Bowman of National Public Radio, the general public holds the military in “highest regard.  It towers above organized religion, big business, and Congress”.  The negative?  Only 40% of civilians surveyed would advise a loved one, friend, or acquaintance to join the armed forces and bear the heavy burdens of military service.

Now, some bad news.  Of the veterans surveyed, 44% experienced a difficult adjustment back to civilian life, 50% reported signs of post-traumatic stress, and 75% live with nightmares and flashbacks from their combat experiences.  And, of the general public, only 25% say they follow the progress of our wars in Afghanistan and Iraq closely, down from about 50% just a couple of years ago.  Marine Sergeant Jon Moulder, interviewed in Afghanistan by NPR’s Bowman, didn’t need the Pew survey to tell him that people back home are losing interest.  “We’re starting to fall by the wayside,” he feels.  “This has been going on for so long.  It’s America’s longest conflict running to date.  Kind of like the bastard children of our generation.”

What’s happening?  Why don’t these wars feel like a national experience?  Paul Taylor, editor of the Pew study, observed, “We’ve never had sustained combat for a full decade, and we’ve never fought a war in which such a small share of the population has carried the fight.”  According to Taylor, just one-half of 1% of the population has served on active duty in the past decade, while 9% of Americans were in uniform during World War II.

Having such a small fraction of the public in uniform this time, according to Martin Cook, a civilian professor of military ethics at the Naval War College, makes it “much more easy to deploy U.S. forces in tough environments for long periods of time because the vast majority of Americans don’t feel they have any skin in the game.”  “I’ve often speculated,” Cook continues, “could we have fought wars for 10 years if this was a draftee army and I doubt it.”

These Pew Research Center survey statistics leave me with a lot more questions than answers.

Are the sacrifices of our veterans – and their families – really “just being part of the military”?  Have recruits been fully able to anticipate the potential physical and psychological health risks of combat?  Did they know just how bad warfare conditions would be in Afghanistan and Iraq?  Did they expect multiple deployments?  Did they realize how menacing it would be to police terrorists embedded within a civilian population?  And, if their “job-related” stress has become debilitating, can service members “quit” – like civilians can – without long-term consequences, such as a less-than-honorable discharge?

Here are some more uncomfortable questions: Do we all agree that the 9/11 attacks – which killed thousands of innocent Americans, and targeted not only our nation but our way of life – required an armed response?  Do we all believe that without our Homeland Security and foreign military commitments post-9/11 more innocent lives would have been lost on American soil?  Haven’t these battles been deemed necessary by politicians on both sides of the aisle?  Hasn’t our involvement in Afghanistan and Iraq in fact benefitted all Americans?

Does the military serve our government, or do they serve us?  Aren’t they fighting on our behalf, for our sake?  Isn’t whatever happens to them in country more than “just being part of the military”, more than just their tough luck?  One of our greatest presidents, Abraham Lincoln, declared in his Gettysburg Address that ours was a government created “of the people, by the people, and for the people”.  Are we willing to uphold this long tradition, sharing in the decisions, commitments, and obligations of our elected representatives?

I believe, as “the people”, that the government’s promise and obligation to restore veterans’ physical and psychological health post-service is our promise and obligation as well.

I know my calling: to provide health and healing for veterans and their families.  To restore them to full participation in life and in their communities.  To say, “Thank you for your service”, in the most practical, effective way I can. And I‘m asking, can we – can you – make a commitment to be better aware of the pressing needs of our returning veterans?  Can we all make a commitment to care?  A commitment to stop the disconnect?

Petaluma Veteran’s Day Parade

On Wednesday, November 11th, Petaluma hosted the largest Veteran’s Day parade in Northern California.  I love my hometown and this parade is one of the things it really does right.  For many years our local American Legion Post 28 has organized the event.  Thousands of people turn out – about 10,000 were expected this year – to pay tribute to our military veterans and service members.

Steve Kemmerle, commander of Post 28, faced a challenge just to make the parade happen.  Because of a city budget crunch, Petaluma officials asked the American Legion group to foot the bill for the extra police and traffic services needed on the day of the parade.  But the Post couldn’t afford the $12,500 price tag.  In order to avoid canceling the event, local businesses stepped in and donated the needed funds.  Like I said, I live in a great community.

This was the first time the Bernstein Institute participated in the parade.  We attached banners and signs to my truck advertising the institute and thanking the veterans for their service.  We said, “We’re here for you” – and we meant it.  My wife, Lynn, had signs made with the Bernstein Institute logo, including our full business title: The Bernstein Institute for Trauma Treatment.

The parade announcers (there were three) had a little trouble pronouncing “integrative”, but they and many spectators along the route noticed “trauma treatment”.  People are becoming more and more aware of the issues of veteran trauma and PTSD.  Almost everyone fervently hopes that real help will be available for vets returning from Iraq, Afghanistan, and other stations overseas who’ve been traumatized by what they’ve seen and experienced.

The parade had over 120 entries, including veterans’ walking groups, military vehicles, a Russian tank and artillery piece, flyovers by a Huey helicopter and a P-51 Mustang, antique cars and trucks, marching bands, Boy and Girl Scouts, color guards, equestrian groups, Civil War re-enacters – just lots and lots of people who wanted to honor our vets and remember their sacrifices.

Army Lt. Col. Steve Countouriotis was Grand Marshall of the parade.  He is a Petaluma resident who served multiple tours of duty flying Blackhawk helicopters in both Iraq and Afghanistan.  Spectators from all generations waved, clapped, and cheered as unit after unit passed.  Small kids waved flags and held up signs saying, “Thank you, veterans!”

We all need heroes to look up to, who inspire us with their courage and dedication to all that we hold dear.  Lt. Col. Countouriotis and other veterans like him are our “giants” and I appreciate their example to us, particularly our youth.

For me, the parade was a wonderful break from my heavy work load.  Don’t get me wrong – I’m grateful to be busy helping so many people who are really struggling right now.  But as I’ve mentioned before, I need to take mini-vacations wherever and whenever I find them so that I can refresh and renew my energy and spirits.  I needed to rearrange my patient schedule in order to take part in the parade and I’m so glad I did.

The weather was perfect – a beautiful fall day with blue skies and sunshine – and I relished every moment I was able to be a part of one of my beloved hometown’s best traditions.  My arm got sore from waving to everyone, but I had no desire to stop.  I saw people I knew and many I didn’t.  I shared a special moment with my family and staff riding with me in the truck.

We had the opportunity to demonstrate our support and belief in what our country stands for.  Veterans lay their lives on the line for our freedom.  Old-fashioned values, like service and sacrifice, are so often the ones that matter most.  They provide the foundation for our cherished way of life.

Thank you Lt. Col. Countouriotis, thank you Steve Kemmerle, thank you veterans of Petaluma and veterans everywhere, of which I am also one.  I salute you.

I Am A Veteran

In 1968, during the Viet Nam era, I enlisted in the United States Army.  I reported for duty at Fort Ord, California, where I went through boot camp and then was trained in advanced infantry.  Most of the men I trained with went on to serve in Viet Nam, but I didn’t go with them.  My father suffered a massive heart attack while I was at Fort Ord.  I was transferred to an infantry training Army Reserve Unit so that I could return home to help my family through our crisis.

I lost friends in Nam that I cared for deeply.  I carry a great deal of guilt and remorse – survivor’s guilt – about it to this day.

My time in the army changed my life.  It brought out the best and worst in me.  It showed me a lot about myself that I didn’t want to have to look at.  Today I have regrets about that time, because when I look back on it I know that I could have done a better job, have been a better soldier.  I lacked maturity and had an enormously negative view of authority.  I didn’t know better at the time, but I still have regrets.

Viet Nam was a different era, and a different war than Iraq and Afghanistan.  Our country was much more conflicted then about our military involvement, and public awareness and consciousness about our role in Southeast Asia was very high.

Frankly, and in contrast, until I enlisted I was in many ways unconscious to myself and to the larger world outside of New Jersey.  I was consumed with pain and anger over my abusive childhood.  I couldn’t or didn’t want to see any other life beyond proving myself on the tough streets of Newark and its nearby neighborhoods.

Then I started losing friends in combat.  And my infantry training was so vigorous and brutal (necessarily so, to try to ensure my survival on the battlefield) that my eyes began to be opened.  I started to consider things about life I had never thought about before – the really “big picture” questions for which I had no answers.

My time in the service was a life-changing experience.  The changes didn’t come from having a wonderful time, for sure.  They came about, like so many other changes in my life, from pain, struggle, and sacrifice.

I was traumatized by my time in the service.  I had many trauma-related reactions after returning home, but because of the rough life I was living I attributed them to my ongoing struggle for survival in New Jersey.  I didn’t realize how bad the whole experience had been until it was over and further events took me out of New Jersey and back to California, this time as a civilian.  Then I really started to feel the painful effects of my time in the service.  But that’s another story, one I may share another time.

A number of my fellow soldiers at Fort Ord were pretty confused.  The trauma from our intense training and from public animosity to the war took its toll.  I remember one guy who tried to use a hand grenade to blow himself up rather than go overseas to kill other people.  If I hadn’t stopped him, he would have taken me with him.  Like I said, it was a very confusing time.

Not like today.  Soldiers today are much more committed and well trained.  They are passionately patriotic.  They deserve our support.  They especially deserve to hear something they’ve told me means everything to them – to hear from us, after they come home, “Thank You”.

This Veteran’s Day, if you know a vet, tell him or her, “Thank You”.  Don’t let feeling awkward stop you.  Don’t let not being able to fathom what they’ve been through stop you.

Viet Nam, Iraq, Afghanistan, the Gulf, World War II – one thing remains the same.  Soldiers experience trauma.  Repeatedly.  Beyond our thanks, they also deserve to receive the help they need to heal and to return to the lives they left in order to serve us.  I want to use what I know to be a part of their healing.  This is what our Veterans Program at the institute is all about, and why I am so deeply committed to it.

It’s just that the need is great, and what our veterans can afford is relatively small.  So, I have a dilemma.  I need your help.  Stay tuned . . . .