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”.