The Epidemic of Military Suicide
The Epidemic of Military Suicide
With understandable urgency, Secretary of Defense Leon Panetta has made suicide one of his top priorities, instructing commanders at all levels to feel acutely accountable for it. The numbers are startling. On average, 1 active-duty soldier is killing himself each day—twice the number of combat deaths and twice the civilian rate.
Suicides have jumped dramatically since 2005 and increased by 18% in just the past year. The DOD and VA are groping for explanations and plans of action—clearly, just commanding the commanders to prevent suicide can't possibly do very much. And, sadly, psychiatry has no ready or certain answers, no sure way to predict or prevent suicide. Research in this area has huge methodological problems and is unlikely to bear any low-hanging fruit. So, we may have to rely on obvious, commonsense suggestions:
1. Stop over-deploying and over-extending our soldiers—withdraw troops from all combat zones as soon, and as fully, as possible. Our continued presence seems to make bad situations worse and entails enormous human and financial costs. It is long past time to cut our losses in these lost causes.
2. Stop the rampant over-medication of our troops with psychotropic and pain drugs. An astonishing 8% of military personnel (110,000 soldiers) are taking a psychotropic medication, often 2 or more different kinds in dangerous polypharmacy combinations. Abuse of prescription drugs is now a bigger problem than abuse of illegal drugs. Simple quality control of physician prescribing habits and pharmacy distribution systems could greatly improve this important contributor to suicide and accidental overdose.
3. Train commanders to combat the cluster effect. Suicide is contagious—each occurrence makes suicide seem a more reasonable choice for imitators. Almost 40% of military personnel know someone who has killed himself. Command should emphasize that suicidal feelings are common and that getting help for is brave and soldierly; but that actually killing oneself is selfish, unnecessary, uncool, and places a grave and lasting burden on buddies, family, and country.
4. Guarantee jobs for vets for the first 2 years after military service—either in the government or the private sector. Financial distress and unemployment are major contributors to suicide. Our discharged troops often have poor future prospects and face stigma on the job market. Many may need a transitional assist to avoid the frustration and dependency of joblessness.
5. Provide extensive and readily available mental health services for identifying and treating depression and PTSD—2 major risk factors for suicide. Treat these more with cognitive-behavior therapy, less with drugs.
6. Provide extensive and readily available substance abuse programs to help alleviate this other major risk factor for suicide.
7. Target special help for soldiers who have gotten into trouble and face administrative or criminal charges—another risk factor for suicide.
8. Provide much more support for families and readily available family therapy to reduce domestic conflict and try to salvage marriages on the rocks.
9. Appropriate gun control laws for all would help reduce the risks of suicide and violence for vets.
10. Avoid future wars of choice. We have fought 3 large-scale, unwinnable wars in 50 years—coming out weaker, poorer, less respected, less feared, no safer, and with generations of warriors who were spiritually and physically wounded. Will we never learn from the past?
The suicide problem is just the very tip of a much larger iceberg. That 1 active-duty soldier per day is desperate enough to kill himself speaks volumes of the less obvious, but significant, distress experienced by many other soldiers and veterans. We have a responsibility to stop over-extending ourselves in poorly chosen "wars of choice" and to pick up the pieces of the harms already done.
I appreciate and applaud the call for more resources for soldiers and veterans that include readily available help in the areas of cognitive behavioral therapy, employment development, legal support, and substance abuse recovery. I hope there is consensus out there that these resources provide common sense protective factors for our soldiers and veterans. I also appreciate your bringing attention to the over-deployment issue.
Yet, I take issue with you, as a medical provider, providing such prescriptive advice on foreign policy. This clearly does not come from a place of consensus. Although well intentioned, you are reaching beyond the scope of your practice when you define the specific strategies that the US should implement to address over-deployment. Beyond that, your overwhelmingly pejorative characterization of the "3 large scale, unwinnable wars" our country has engaged in approaches the same kind of black and white thinking that puts our soldiers at risk. Societal moral condemnation of our soldiers' efforts is an environmental risk factor for military and veteran suicides. For more on role of moral condemnation as a risk factor for our soldiers, please read On Killing by Dave Grossman. To put this idea in the context of one of our current evidence-based practices, I will borrow a term from Cognitive Processing Therapy. We need to be aware of the 'stuck points' of shame and blame on an individual and societal level if we are going to effectively address this issue.
The Greek Civilians role-modeled a level of solidarity with their soldiers that we could learn from. My hope is that my opinions about the need to address all the protective environmental factors for our troops will eventually be considered 'common sense'. The magnitude of this problem that includes one active duty military and 18 veteran suicides per day in our country calls for attention to all of the risk and protective factors at play.
Tom Bieri, MFT
Recruitment of individuals with prior suicide attempts and mental problems by recruiters in pressure to "make their quota" who facilitate the recruit in falsifying their documents account for up to 40% of the suicides.
a help line no. should be made of psychiatrist or a trained mental helth professional who can help indl in condition of extreme crisis.
also most common stressor for military suicide is domestic problems which should be adressed carefully.
To Psychiatric Times
Message box
September 28, 2012
Re: The Epidemic of Military Suicide, by Allen Francis, Sep. 19, 2012
It seems unusual that marriages and their 'salvages' are listed on the 8th position, out of 10, as risk factors for suicides of young people such as soldiers. Love and intimate relations with girl-friend, fiancé, and young bride are not even mentioned under the entry of marriage ('on the rocks'). Perhaps such family matters should be placed among the few at the top of the list.
In my view, it is not the feeling of shared "shame and blame"of the official policy which might affect a soldier, but a deep feeling of personal failure in a given situation of separation in far away places and wars. Let us not forget that back home there is an unremitting rampage of anorexia-bulimia (conveniently but wrongly called 'eating') disorders in young female population, schoolgirls, college students, other young women, along with an unabated epidemic of breast cancer in middle-aged women. Not only the soldiers, but the half of population, women and girls of all adolescent and adult ages, are under a societal distress, with inevitable biological roots, causes, and consequences. Despite the pinky and buoyant presentation of the hazard-threatened situations and lives of women, the fact emerges that the evident burden of morbidity in women reflects a high degree of misunderstanding of and ignorance about the intimate (sexual) micro-environment and of the primordial reproductive biosystem of woman-man relations. The ubiquitous condomization of female sexuality, defined as a root cause of many female- specific diseases, does not create a mutual, inter-gender bonding among lovers, partners or married parents. An unattached and unsatisfied female, besides divorce and animosity, turns paradoxically against the partner. A young soldier, confined in a distant place feels totally helpless to amend the internal alienation and personal rift. A terrible feeling of an unexpected falling of the roof develops in the home, of a personal failure of dreams and love and family, with supposed no prospect of repair. No missed higher education, unemployment, or business collapse could replace the feeling of demolition of intimate personal relations.
Prevention of suicide epidemic in the army and in the society at large should start back home, with better understanding of personal and familial relations and the hidden factors which destroy them in the society.
Arne N. Gjorgov, M.D., Ph.D. (UNC-SPH, Chapel Hill, NC)
Author of "Barrier Contraception and Breast Cancer," 1980: x+164
11. leaglize cannabis for treating PTSD. In my practice, cannabis has proven to be the most effectiove medication available for treating PTSD and rapidly alleviating suicidality.