Military Suicide and Military Families: Part 3

Military suicides happen far too often.  Alarming statistics from studies of suicide by active duty service members and veterans both paint a tragic picture.  The years of combat in Iraq and Afghanistan, the multiple deployments, have taken their physical and emotional tolls.  Over the last few months, I’ve kept this issue in the forefront of my blog posts.  Lately, I’ve highlighted a side to military suicide about which few studies have been done and statistics are largely unavailable: suicide by military spouses.

I’ve drawn heavily from the words of 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.  I’ve reviewed the symptoms of post-traumatic stress (including suicide and suicide attempts), and the inadequate mental health treatment currently available to military spouses.  Today I’m going to go into more detail about the stresses experienced by military families.  I’ll conclude with Deborah and Kristy’s suggestions for ways the Departments of Defense and Veterans Affairs could better serve the mental health needs of military families.

In January, 2011, Deborah Mullen addressed the Military Health System Annual Conference.  She opened with a direct quote from a letter by a young military spouse.  “It is infinitely worse to be left behind,” she read, “a prey to all the horrors of imagining what may be happening to the one you love.  You slowly eat your heart out with anxiety and to endure such suspense is simply the hardest of all trials that come to an army wife.”

The letter’s young author?  Libby Custer, wife of General George Custer, writing in May of 1876.  “The nature of war changes,” Ms. Mullen observes.  “Weapons get smarter . . . tactics get sharper . . . breakthrough medical advances save more and more lives.  But the stress and the anxiety felt by those who are left behind NEVER changes.”

Besides the agony of waiting, other sources of stress for military spouses and families include reintegration and reunion challenges, Deborah explains.  “A combat tour may last a year, but the effects of that tour on the service member and family may last much longer.”  Spousal and child abuse cases are rising in military families.  Families of service members who’ve sustained serious physical injuries may endure long-term relocation to receive treatment, and children “may be left at home with family or friends”, breaking the immediate family apart.

Or maybe the returning service member has suffered the signature wound of our Iraq and Afghanistan conflicts: an “invisible” wound from PTSD or TBI.  Spouses and children “don’t understand why their parent looks the same, but isn’t the same,” Deborah continues.  And “for those children whose mom or dad died – either by the enemy or by their own hand – this war will never really end.”

How can the DoD and VA better serve the mental health needs of military families?  Deborah Mullen and Kristy Kaufmann, writing for the New York Times, make the following key suggestions:

1. Really listen to military families, look at things through their eyes, to better understand their special needs and challenges.

2. Provide “home-centered” assistance for families in crisis, in which counselors and other assistance personnel come directly into the home to provide needed support.

3. Do a better job of following up on the results of programs currently in place.  New programs are being created all the time, but too often they aren’t reviewed and modified, as necessary, to become truly effective.

4. Develop a more holistic strategy that integrates military families and community support.  Society has a crucial role to play in helping keep military families strong and healthy.

“Ultimately,” Deborah concludes, “spouses tell me they don’t need another program, they don’t need more training.  What they need – what they want – is time.  Time with their spouses.  Time together with their family.  Time with a counselor or a doctor or a minister.  They want time to explore and understand what is happening to them . . . and the patience and understanding of loved ones, friends and the system itself.”

“If you have a broken family,” Kristy warns, “chances are you’re going to have a broken soldier – and vice versa . . . . It will take a nation working together to keep us strong.”

As a young Marine wife told Ms. Mullen, “It doesn’t matter if it’s the first day they’re gone, or the last day before they return home, you’re scared all the time.  You pretend to be happy, but you’re living in fear.”  And, Deborah urges, military spouses should not have to face that fear alone.

Through my work, I’m committed to the health and well-being of our nation’s service members and their families.  I don’t want them to be left alone to struggle with their issues of emotional trauma and post-traumatic stress.  I encourage you to join me, in whatever way you can.

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.

No, It’s Trauma

Last week I wrote about two fictional couples, the Morrows and the Bodens, as they faced a sudden, forced move from their homes in a foreclosed apartment building.  I used their scenario of dislocation to illustrate the differences between stress and trauma.  I mentioned that many of the people I meet and talk to believe they’re under enormous stress during this, our Great Recession, but would deny that they’re experiencing trauma.  In my professional and personal opinion, I disagree.  I think many, possibly most people don’t understand what trauma is, and have actually been traumatized rather than just stressed by the events of the recent past.

Most often, when people hear the word trauma they think of some horrific and shocking event.  They think of tragedies like car accidents, violence and brutality, death – something horrendous and devastating.  These kinds of events are certainly trauma: a type called shock trauma.

But there are many other traumatic experiences that, while not shocking, are beyond the ordinary.  Extraordinary experiences beyond normal fears and normal circumstances can produce a kind of trauma, too.  When these events occur repeatedly over a period of time they erode our physical and emotional reserves.  They can be very strong and significant and extremely destructive.  I see the symptoms of our “wearing down” in higher divorce rates, higher suicide and suicide attempt rates, and higher rates of disease and depression.

If you wondered, when you read last week’s illustration about the Morrows and the Bodens, whether there might be “more to the story”, you were right.  What if I were to go back in the history of the two families, and fill in some of the gaps?

Take Mr. Morrow, the head of the family who experienced stress, rather than trauma, from their enforced move and handled the transition in a healthier way.  Let’s say, pre-move, he had enjoyed the security of a steady job for the last decade, he and his family were in good health, and had maintained close, loving ties with friends and an extended family of supportive relatives.

Now let’s take Mr. Boden, whose family suffered significant trauma around their relocation.  I could shed some light on his struggle by proposing that his family’s move was just one more trial in a series of unfortunate recent events.  Let’s say he was laid off three years ago and has been alternating between unemployment and scraping together small jobs since then.  Let’s say he has chronic back pain, his wife has stress-induced migraine headaches, and his kids aren’t doing well at school.  Let’s say, even, he’s the son of an alcoholic father who was unavailable both in the past and the present.

My point is that at the outset, going into this sudden and difficult need to move, Mr. Morrow had physical and emotional reserves that Mr. Boden did not.  And how many of us can confidently say, after over three years of economic and personal hits, that we still have plenty of energy reserves for the continuing challenges coming almost daily down the road?

In 2008, when the stock market fell, and the real estate market tanked, and jobs started to disappear – when the Great Recession got its start – we all felt shocked, we all felt traumatized.  Even though it had been coming for a while, it was a shock when it first hit, and it hit fast and hard.  And it was devastating.  That we’re still in pretty much the same place, three years later, is one of the things I think is unique to this period of time.  I see that people are somehow getting used to our hard times and adapting in some ways, and so they don’t realize they’re experiencing ongoing, or developmental trauma.

Developmental trauma occurs when an individual experiences a series of events which may or may not be shocking of themselves, but are painful, disturbing, and overwhelming.  This type of trauma is called “developmental” because it disrupts the normal intrinsic development, or maturation, of a child or adult.  A child suffers developmental trauma, for example, when they are subjected to repeated verbal or physical abuse.  Adults can experience developmental trauma also, when the circumstances of their lives prevents them from growing or thriving in physical, emotional, mental, or spiritual ways.

The economic straightjacket of our recent past has put a severe limit on opportunities for adults to grow and prosper.  People are feeling thwarted and trapped in their efforts to provide for themselves and their families.  They’re learning to adapt, or they’re dealing with their frustration and pain by going numb.  Some of us respond to crises with denial.  Some of us respond with action; some of us tend to freeze into paralysis.  There are many things people do to survive in times of crisis and difficulty.  In the meantime, whether they feel it or not, they’re frying emotionally and physically.  Their systems are under siege, 24/7.

My heart goes out to all of you who find yourselves in this painful, devastating situation.  I too have experienced recent financial trauma.

In the hope that it will provide you some relief, I promised last week to include suggestions for how to deal with ongoing stress – the “wealth, health, and stealth” kind.  These suggestions may make it possible for you to keep your unavoidable stress from turning into avoidable trauma.  You saw some of these ideas at work in the story of the Morrows and Bodens.  In the midst of difficult circumstances and events, I encourage you to try the following:

1. Slow down, don’t panic
2. Remember you’re not alone
3. Think through your options
4. Ask for help, don’t isolate yourself
5. Take good care of yourself physically and emotionally
6. Don’t blame yourself for things beyond your control
7. Reduce the pressure on yourself in every way possible
8. Keep your perspective, others are suffering too
9. Look for ways to help others, and to give back to those who’ve helped you
10. Don’t lose hope, focus on the positive

These ten steps are fairly simple, but I know they are truly not easy.  I’ll be back next week to go through these steps in more detail.  I’ll provide suggestions for how you can get started using these steps in real-life, practical ways.  I know these steps can help you, because I use them and teach them to my patients, and I’ve seen them make a world of difference in these hard times.  I encourage you to give them a try.