Tuesday, January 24, 2012

Military Suicides: Those We Might Yet Save

By Penny Coleman

When my husband Daniel came home from Vietnam in 1969, he was a mortally wounded man. Some essential part of him had been damaged, but the damage was invisible from the outside. On the inside, something malignant had implanted, something that would fester and ultimately prove to be as lethal as any bullet or bomb.

Soldiers throughout the ages have suffered traumatic injuries in response to the horrors of war. When their most basic beliefs about right and wrong, conscience, compassion and humanity are shattered, they can be transformed in malignant ways. For some, the urge to destructive behavior will be directed outward, devastating their families and support networks, their careers, their place in the world. When their lives spiral out of control, many of them will end up behind bars. For others, the urge will be towards self-destruction. They will risk and abuse their bodies, and far too many will die by their own hands.

Daniel was a beautiful, gentle, funny, vulnerable man, but he was also hurt in ways that neither of us understood. One minute he would be throwing sticks for the dogs and the next he would be throwing coffee cups at me. The next, he would take to his bed with the blinds drawn insisting he didn’t want to live. His rages were frightening. His nightmares were terrible. He drank too much, smoked marijuana all the time, carried a zip lock baggie with different colored pills for different occasions, dropped out of school, lost three jobs in as many years, and held me much too close. When I tried to pull away, he tried to kill himself. Twice. When I finally left, he did.

For decades, I believed that his death was my fault. If only I had been kinder, more patient, listened better, noticed more, intervened faster. But in the early 70s, there was no such thing as PTSD—at least officially. Daniel was dead and I had failed to keep my man alive. The rumors that more Vietnam veterans had taken their own lives since coming home than had died in the war were yet to be heard, much less confirmed.

So it was with heartbreak that I witnessed only a generation later, history repeating itself. Months after the U.S. invasion of Iraq, an upsurge in soldier suicides prompted the Army to send the first Mental Health Advisory Team (MHAT) to investigate. Since then, the MHAT experts reported back every year that soldiers were killing themselves for the same reason soldiers "typically" kill themselves: "insufficient or underdeveloped life coping skills." More specifically, they had failed to manage their financial, legal, substance abuse, and especially their relationship problems.

I know that accusing finger all too well and I resent the implication that Daniel died because somehow we failed. At his funeral, his brother gave the shortest of eulogies: "It was the war." Then he sat down.

The military has long associated the breakdown of soldiers, and its most extreme manifestation in suicide, with weakness or character flaws, inherited or accrued as part of an aberrant psychological history. This focus on individual tendencies and constitutional inferiorities has had seriously negative implications for psychologically injured soldiers and their families, including the denial of treatment and disability compensation.

At the same time, blaming individuals has buttressed the stigma that encourages those in distress to be ashamed, to try to deny their symptoms and manage on their own, and their families to share their shame, and forgo advocacy and protest.

Pointing fingers of blame at the dead and those who mourn them, however, has not staunched the flow of self-inflicted deaths. The numbers have continued to climb, inexorably, defying official explanations and attempts to intervene.

And the numbers are terrible. For soldiers, the latest estimates are one suicide every 36 hours, a number that for three years has exceeded combat deaths in Iraq and Afghanistan combined. For veterans, the estimate is one every 80 minutes, twice the rate for the civilian population, and for young female veterans, three times.

Even those statistics don't begin to describe the true scope of the current tragedy because for each such death untold other lives are irreparably impacted. The families of the dead are devastated, their futures diminished, their children far more likely to take their own lives.

Military suicides are not a new phenomenon. Though that inconvenient truth has been repeatedly forgotten or ignored, history suggests that the stressors of war have had similar effects on soldiers throughout the ages. Since the American military began documenting such deaths in response to soaring rates during the Civil War, suicide has been, quite simply, an inevitable cost of war. Every war. It was the leading cause of death among military personnel for almost two decades following World War I. The "most comprehensive follow-up" of Army and Navy veterans following World War II found an unexpectedly high suicide rate among their subjects, and in 1958, two VA psychologists, daunted by the many suicides among their veteran patients, opened the first suicide prevention center the country. Researchers studying suicidality among Korean war veterans in 1994 were "surprised" to discover that the statistical incidence of such deaths was virtually identical to that of Vietnam veterans.

For more than a century, trauma researchers have recognized that responsibility for killing another human being is "the single most pervasive, traumatic experience of war," followed closely by witnessing or failing to prevent killing—even learning about suffering and cruelty that are inconsistent with one's beliefs about the nature of humanity. All are predictive of traumatic injury, of justice contact, and far too often of suicide.

The military has tried to predict the successful warrior, only to discover that all human beings have breaking points. They have sought in vain for some pharmaceutical that would act as "psychological Kevlar," again to no avail.

Their latest intervention strategy, Comprehensive Soldier Fitness (CSF), promises to build such warriors through a program that teaches resiliency, teaches soldiers to respond to stressful situations with positive emotions, like optimism and cheer, and to sublimate "negative" emotions, like anger, fear and grief. "Posttraumatic growth" has become the new standard to fail by. Those who have absorbed the training will, in theory, experience adversity as an opportunity to grow and flourish, but implicit in that is the accusation that those who are overwhelmed have not tried hard enough.

The Army is funding this experimental initiative to the tune of $31 million dollars, despite the fact that previous studies have included only civilians, and have reported little or no demonstrable reduction in symptoms.

Neither has the program's alarming potential for harm been investigated.

Consider the possibility that an overly optimistic soldiers might underestimate real danger, compromising not their safety, but that of the entire unit. Or the soldier who feels shame because he cannot access anything positive in the persistent invasive image of a dismembered friend. Or the female soldier asked to be resilient in the aftermath of rape.

The harsh exigencies of military experience, and of combat in particular, often warrant "negative" emotions. Those emotions are the normal, healthy, even the moral, human responses to terrible circumstances, and they are reflections of those human qualities, conscience and compassion, that are most sacred and precious.

So the over-arching questions become: Do we really want to build psychically armored soldiers, inured to their own suffering and that of others? Do we really want to punish soldiers and veterans for behaviors long recognized as symptomatic of injuries that are a direct result of their service?

Some researchers and practitioners, Jonathan Shay first among them, have long been pressing for a paradigm shift that recognizes the gross miscarriage of justice that has been-- continues to be-- done to those who have risked and sacrificed so much.

Shay's proposed shift rejects the language of "disorder," which continues to emphasize individual vulnerabilities, in favor of "moral injury" which he defines as, "a betrayal of 'what's right' in a high stakes situation by someone who holds power."

The term "moral injury" has been gaining traction, both in research and tentatively in VA parlance, but it is a watered down version of Shay's definition, recognizing only the betrayal and the high stakes, but ignoring the agency of those in power.

Obviously, and by definition, the morality of healthy human beings is challenged by military experience, especially in the context of war. Violence and aggression are encouraged; killing is considered necessary; innocents die; atrocities occur; and soldiers continue to blame themselves and to be blamed by society. That kind of moral injury will only be ended when human beings end the practice of war. Given the world we currently inhabit, that is not likely to happen any time soon. Shay chooses rather to put his energies into what can and should be changed, specifically the practices, policies and culture that contribute to command and leadership failure to prevent avoidable moral injury.

When political justifications for wars prove to be dishonest and dishonorable, when established protective protocols are ignored and safety measures short-changed, when promises of support and care are offered and then withdrawn, soldiers are doubly betrayed. There is no communalization of pain or responsibility. They are made to feel disposable, abandoned, with both social and personal trust undermined. "They lose their sense that virtue is even possible," says Shay, and the psychic effects of such a multifaceted injustice are "catastrophic."

I don't know what happened to Daniel in Vietnam. When I asked, he just said: Vietnam happened. But I know that his silence masked terrible guilt and betrayal. Had he lived, his destructive urges might well have landed him in prison. Instead, he put himself to death. In some combination of euthanasia and execution, he ended the unbearable pain of his memories, and, at the same time, exacted punishment for sins, his own or others, that violated his conscience.

Finally, the only reliable way to end this epidemic of military suicides is to stop sending young men and women to war. Barring that, a serious effort will recognize that explanatory paradigms of blame have failed to stop the self-inflicted deaths. The most vulnerable are those whose already injured psyches are confronted with additional and unnecessary injustice. Those are the lives that might yet be saved.
Penny Coleman is author of "Flashback" and advocate for veterans issues.
Citations for this article are available at: http://www.justicepolicy.org/news/3431

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