If you had a a family member commit suicide in the military, then please do not read this post.  It is not for you, and running back over it all, wondering what was to blame and whether there was anything anyone could do is masochism, you will not find anything comforting here.

Probably the only consolation possible:

Now there is one thing I can tell you: you will [eventually] enjoy certain pleasures you would not fathom now. When you still had your mother you often thought of the days when you would have her no longer. Now you will often think of days past when you had her.

When you are used to this horrible thing that they will forever be cast into the past, then you will gently feel her revive, returning to take her place, her entire place, beside you. At the present time, this is not yet possible.

Let yourself be inert, wait till the incomprehensible power ... that has broken you restores you a little, I say a little, for henceforth you will always keep something broken about you. Tell yourself this, too, for it is a kind of pleasure to know that you will never love less, that you will never be consoled, that you will constantly remember more and more.

I.

For the rest of us, this is how you don't reduce military suicides.


Military suicide prevention efforts fail: report


Here are the cited reasons:

• Each branch of the services rushed to create a suicide prevention program, but there was no coordination.
• prevention training often failed because those running the sessions did not understand their importance
• "It is not just the perception that they will be treated differently or somehow that it will affect their career, but it is also distrust in the system and distrust that mental health professionals can help them"
• "A large percentage of our servicemen, our veterans, do not come in to get help"
• "They don't trust us. They believe we speak with forked tongues," Bradley said.

Or, the conclusion of General Peter Chiarelli, vice chief of staff of the Army, before the Senate Armed Services Military Personnel Subcommittee:

"I think it is the cumulative effect of deployments from 12 to 15 months"

Of course: war is hell, and sometimes it's too much for some people.  Right?

II.

You might think that would be the last thing a general would say, especially since deployments are scheduled to get longer.    

And there's a substantial political desire for it to be true, to have yet another reason to end the wars.  I don't blame them; nor am I saying I wouldn't similarly manipulate the truth if I thought it would save lives, but I don't lie to myself.  You keep two books, not no books.

III.

Here's the important part of the data that is usually not included, not here or here or many other heres: 30% were deployed, 35% were post-deployment, and 35% were never deployed.

Those three populations are totally different.  Whatever it was that happened in battle could not have happened before you got to the battle.  This suggests that the approach for the never deployed be different than the currently deployed. Duh?

Second, in showing the official conclusion of the military, you might ask what they don't want the answer to be.  In other words, not what is the benefit from this being the answer, but what is the benefit in it not being something else.   And that something else is physical traumatic brain injury.

And now we're into a longstanding, very real, military question: what is PTS(D)?  Is it all physical, all mental, or both?  What about mild traumatic brain injury-- all concussion, more than concussion, what?  You can get "treatment" at any VA hospital regardless of what you call it, and (hopefully) doctors will look at the MRIs or the psych scales and treat what they need to treat, but the military won't formally call it anything until the money side is worked out. That money side is Congress's willingness to cover disablities and liabilities, and that willingness is entirely dependent on the reaction of the voters to the price tag.  In other words, whether the suicides are the result of psychiatry, neurology, biology, divorces or explosions depends mostly on you.

III.

Here's a first step: take the management of suicidality in the currently deployed combat soldiers out of psychiatry.

What do you want to do here?  Is the goal to reduce suicides or is the goal to "offer services" and "promote awareness?"  It doesn't matter if suicidality is 100% genetic, you approach it like it's not.

Here is a statement, your reaction to which will quickly determine your interests lay:  the only thing less effective than telling these soldiers that the solution is psychiatry is to add that the psychiatrists are all gay.  Pray on this.

If we're pretending these psychiatric illnesses are real medical diseases, then we must defer to the patient's prejudices.  And, my experience: soldiers don't like shrinks unless they're trying to be ex-soldiers, and then they only pretend to like us.  And they don't trust that shrinks are not a sandwich away from going Columbine themselves, not least because one of them actually went Columbine, well after we were supposed to be "aware" of the "causes" of Columbine, and none of the other psychiatrists noticed.

Some of them maintain themselves on bravado and denial, they think that if they get their arm blown off in a fight, they're just going to special forces everybody down with the good hand.   Why would they admit to a mental illness, even if that's actually the problem?

You most emphatically cannot tell them that depression is a real medical illness with biological underpinnings that can affect anyone, from the Denver housewife to an Airborne Ranger, because you cannot make a soldier feel that his situation has anything in common with a Denver housewife's.  At all.  Because the more he believes you the more he won't show up.

It's revealing that the conclusion everyone has reached about these suicides is that "war is hell," yet the proposed solution has nothing to do with war.  It more closely mirrors the kind of management I give a man traumatized in a waverunner accident.  Are they similar?

Hence, the way to approach suicide prevention is to make suicidality/stress a rare, though entirely expected consequence of battle.   Not to over analyze it, but to acknowledge it.  In short, not to pathologize it, but to mainstream it:  "Yeah, me too."

IV.

You can stop sending more psychiatrists: 40% of the suicides are already in treatment and on meds.  In regular America, only 25% of suicides have never seen a psychiatrist.

But if only it were so easy.  Here are three factors that make military life nearly unbearable, that we don't hear about:

One: deployed soldiers are still in contact.  Not only do they have the stress of war, but they also have an almost real-time update of the stresses at home.  In Vietnam your wife wouldn't bother to mention the boiler broke down, now you get to know that fact the same day you shot/got shot by 6 people. You are doubly burdened and doubly powerless.  Not to mention get to watch your marriage deteriorate in serialized emails while you're statused about her  increasing happiness through facebook.

Third: 2% of the Army's drug screens come back positive.  2%.  Includes Afghanistan.  Where they invented heroin.  2%.  Even as 25% admit to abusing-- not using, abusing-- painkillers. 

Fourth: gangs: it's not the crimes, but the hostility, the fear and the marginalization.  Try being an enlisted guy on a carrier looking to use the gym.  Want to know what movie ordinary Army life isn't like? The Hurt Locker.  What it is it like? Training Day.  I'm exaggerating?

1. Those are bazookas.
   
2. Those are gang signs.
   
3. Those are women.

V.

Psychiatry may be the way to handle the non-combat suicides, but it clearly isn't working for the combat/post- combat PTS(D) group.  So there's this:

Here's what PTSD is like, and why people kill themselves over it. Think of life like a cave. If I send you into a cave with a lantern and tell you there are no bears in the cave, you feel safe. You will walk around the cave and enjoy yourself. Now what if I give you a lantern and a gun and tell you that there is a bear in there? You can still go down, but you'll be careful to look for the bear and ready to run or shoot if you see it. Now, what if I send you down there with a gun but no lantern and simply say "bear" to you? Pretty soon, you're in there, you can't see the way out, and every rock you bump into feels like a bear. After a long enough time being down in the cave, you realize you don't have enough ammo to shoot everything that might be a bear. It has nothing to do with running out of food or water or feeling like you're fighting some unwinnable battle with the bear. You just get sick and tired of the uncertainty. Are you going to live through the night? Are you going to wake up to a bear gnawing your intestines? You get to the point where you just wish the bear would come along and end it. And when he doesn't come, you decide to do it yourself.

Couple that with a winning facebook update, and you're set.

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